In Mexico, approximately 100,000 healthcare-associated infections are registered every year, which cause two to three percent of patients to die from resistant bacteria, and it is estimated that by 2050 they will be the leading cause of death worldwide, warned María Guadalupe Miranda Novales, coordinator of Activities of the University Plan Network for the Control of Antimicrobial Resistance (PUCRA Network) of UNAM's University Health Research Program (PUIS).

"We say that it is a silent pandemic because it is not seen, it is not announced, but, unfortunately, people die in hospitals due to infections caused by resistant bacteria," said the university specialist. In the United States - where there is greater epidemiological monitoring - in 2019, 2.8 million sick people and more than 35,000 deaths were recorded due to bacteria resistant to antimicrobials, added Miranda Novales. On the occasion of World Antimicrobial Awareness Week, which will be held from November 18 to 24, the pediatric infectious disease specialist recalled:

This commemoration was established in May 2020, when the Executive Committee that includes the Food and Agriculture Organization of the United Nations (FAO) and the World Organization for Animal Health (OIE), and the World Health Organization (WHO) created this campaign. The aim is to raise awareness of the global phenomenon of drug resistance, encourage the general public, health workers, and policymakers to prevent and contain its spread.

This fight requires a tripartite alliance and to be approached from the integral perspective of One Health since the use of antimicrobials is also used inappropriately as growth promoters in animals and some crops added the researcher attached to the Research Unit of Analysis and Synthesis of Evidence at the Centro Médico Nacional Siglo XXI. In this context, the National University will offer free of charge the course "Antibiotics: how, when and what for?", open to the general public, through the Coursera platform.

Epidemiological surveillance in Mexico

The professor of the Master's and Doctoral Program in Medical, Dental, and Health Sciences at the UNAM School of Medicine recalled that a goal proposed by the WHO is for countries to reduce the use of antimicrobials by 20, 30, or even 50 percent. In 2017, the National University created the University Plan for the Control of Antimicrobial Resistance and in the last four years, it has been dedicated to reviewing what the national panorama is in this area. It has the support of about 30 institutions and hospitals in the country, which provide information on thousands of bacteria isolated from blood and urine.

The consumption in hospitals of the Network is also recorded, and although they observe a decrease in the use of antimicrobials, it is still minimal. For the expert, it is necessary to expand the work with the first level of care medical personnel, that the authorities supervise the prescription of these drugs, including raising awareness in the community in general so that when a person goes for consultation for an acute respiratory disease, he/she does not demand that an antibiotic be prescribed. "This problem is everyone's problem, not just that of the doctors, nor the antibiotic manufacturers, it affects us all and a small participation can mean a lot," she considered.

Adaptation

A member of the National System of Researchers (SNI) explained that as part of their evolutionary process, bacteria adapt, modify their genetic material, mutate and become resistant even to environmental substances. In the past, as there were reduced groups of drugs and bacteria were less exposed, several died and some survived, but in a quantity that did not represent a problem for the health of the individual. Today, there are drugs with different mechanisms of action, and a single bacterium can mutate and end up with five, six, or 10 "weapons" that defend it.

"Moreover, bacteria can exchange their resistance mechanisms, they manage to transfer genetic material to each other, even in bacteria of different genus and species. This has generated mechanisms that are highly adapted to their survival and they are winning the battle against antibiotics and our defense mechanisms, by preventing us from eliminating them," she concluded.