Antibiotic resistance, a public health challenge

by time news

► Why is antibiotic resistance so worrying?

One figure is enough to understand the scale of the problem: in 2019, 1.27 million people died of an infection resistant to antibiotics, according to a study published in the medical journal The Lancet. Either more than because of AIDS or malaria. “By 2050, antibiotic resistance will be the leading cause of death worldwide”, emphasizes Emmanuel Piednoir. This specialist in infectious diseases at the Avranches-Granville hospital center (Manche) affirms it: «Ten years ago, I never had a GP phone call to treat a multi-resistant germ, now I have at least one a week. » Among the most common: Enterobacteriaceae, such as E. coli or salmonella, or even staphylococci aureus.

Identified by the WHO as one of the ten greatest threats to public health, these multi-resistant bacteria could do significant damage. «A world where antibiotics no longer work is the world of the trenches of the First World War, where the slightest wound in unsanitary conditions can sign a death warrant. It’s a world where surgery is risky, where cancer chemotherapy is not possible.” lists Emmanuel Piednoir.

This is a scary picture. Faced with the emergency, the French government launched, in February 2022, a national strategy for the period 2022-2025, built on two axes: improving the prevention of infections on the one hand, and limiting the use of antibiotics on the other hand. somewhere else.

► How do resistances appear?

Antibiotic resistance is neither more nor less than the result of bacterial evolutionary mechanisms. To block the bacteria, the antibiotic erects a wall, against which most pathogens will stumble. But some bacteria that are more malignant than others grow wings, to fly over the barrier. “The effectiveness or ineffectiveness of antibiotics is only related to the resistance of the bacteria itself, and not to the immunity of the patientrecalls Emmanuel Piednoir. But some bacteria, like Escherichia coli, adapt very quickly.

“There are even some antibiotics for which resistance appears almost instantaneously.adds the anthropologist Charlotte Brives, who has just published Facing antibiotic resistance. A political ecology of microbes (Ed. Amsterdam). Penicillin resistance, for example, emerged within two years of its discovery. » If the phenomenon is therefore far from being new, it now concerns the entire planet, humans as well as animals and plants. Blame it on overuse of antibioticss. «Using an antibiotic for other things than saving lives overuses the molecule,” denounces Jean-Yves Madec, head of the antimicrobial resistance unit at ANSES.

For Charlotte Brives, a large part of the responsibility lies with “the agro-industry and intensive animal husbandry that underpinned the great acceleration after World War II”. Admittedly, the European Union has banned the use of growth antibiotics in livestock farming since 2006. “But this is not the case in other countries like China, points out the anthropologist. However, the fight against antibiotic resistance is taking place at the global level. As for Europe, it continues to use preventive and curative antibiotics in farms. »

Significant progress has nevertheless been made. «Taking all molecules together, the use of antibiotics has almost halved over the past ten years in veterinary medicine.says Jean-Yves Madec. For some, such as the latest generation cephalosporins or fluoroquinolones, we even have a 90% drop.» To achieve this reduction, vaccination and hygiene in farms have been reviewed. “Uses have also been purely and simply stoppedcontinues Jean-Yves Madec. Any use outside of a care strategy must be banned; antibiotics are not food. »

However, overconsumption in human medicine remains problematic. «General practitioners are under a form of pressure from their patients, who demand a prescription», recognizes Emmanuel Piednoir. Some experts are annoyed to see a peak in prescriptions in winter, even though most diseases in this season are viral.

For the moment, France, a large consumer of antibiotics compared to its European neighbors, experiences few situations of therapeutic impasse. «But this forces us to use antibiotics of last resort, often intravenously and in the hospital, testifies Emmanuel Piednoir, who describes a vicious circle” “. The more we use these antibiotics, the more bacteria will be resistant to them, and the fewer possible solutions we will have. »

► Why aren’t new antibiotics being developed?

Not so simple, answers Emmanuel Piednoir. “The search for new molecules is very expensive, and it’s a race against time: bacteria will eventually become resistant to these new molecules as well. »

In 2019, only 32 antibiotics in development attacked the list of “priority” pathogens established by the WHO. « TheThe very principle of a new antibiotic against resistant bacteria is to use it as little as possible so that it remains effective. However, when you are an industrialist, you do not invest to develop a product that, by definition, you will not sell or sell very little »justifies Thomas Borel, scientific director at Leem (the union of pharmaceutical companies).

To remedy this, States are increasing funding and public-private partnerships to create new antibiotics. France, as part of the plan « France relaunch” and a priority research program, has released several tens of millions of euros. These efforts are found at European level, to rethink the industrial sector. “Medicine companies are also mobilizing, with a billion dollar fund launched in July 2020, to achieve two to four new antibiotics by 2030”, defends Thomas Borel.

► What are the alternative solutions?

Beyond the development of new molecules and best practices, the most promising avenue concerns bacteriophages. «These are very common viruses that only infect the bacteria responsible for the infection and destroy them,” explains Marie-Agnès Petit, research director at Inrae. Discovered at the very beginning of the XXe century, they were used in the fight against infections under the impulse of the French biologist Félix d’Hérelle.

The principle of injecting viruses to destroy bacteria may raise some eyebrows. «Bacteriophages are not dangerous because they are specialized, unlike broad-spectrum treatments, specifies Agnès Petit, head of a laboratory on these viruses. If you are being treated for Clostridium difficile, it will not attack other bacteria and not even other Clostridium. » They also have the advantage of acting very quickly, “in the space of a few hours to a day. Then the immune system wakes up and destroys them, describes the specialist. The speed of improvement in the patient is also very impressive when the treatment works. Widely used in the former Soviet bloc countries, notably in Georgia, phage therapy no longer exists in France except in rare cases of compassionate use, when nothing else works. “These treatments were still found in pharmacies until the 1960s, but antibiotics, which are more practical to administer and more effective, have supplanted them.recounts Marie-Agnès Petit. Today, it is used for cases of resistant Staphylococcus aureus infections, in hip prostheses for example, or for pulmonary infections linked to cystic fibrosis.. »

If other avenues are being studied, antibiotic resistance requires above all to rethink what Charlotte Brives calls “the drug infrastructure”. “It’s very good to produce new antibiotics and develop alternatives, but to have answers that meet the challenges, we have to question their use. » Which also requires changing our view of bacteria, not all of which are good for eradicating.. “Work on the microbiota shows that many bacteria destroyed by antibiotics are necessary for the functioning of the human body. Other studies have shown that the magnificent decline in infant mortality and bacterial infections over the past decades has been accompanied by an increase in a host of autoimmune diseases, she points out. We also need to be infected to stimulate our immune system. »

Should we then “learn to live with” bacteria, as we are trying to do with the Covid? “In some cases, you can live very well with the infection quietly, without suffering the inconvenience of the side effects associated with antibiotics, says the anthropologist. Because no matter what we do, the bacteria will always win the battle. » Better to target the enemy well.

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France consumes a lot of antibiotics

France is in the top 5 of European countries the biggest consumers of antibiotics.

628 tonnes of antibiotics were sold there in 2020 for human health, and 451 tonnes for animal health, according to the High Authority for Health.

Consumption fell by more than 25% in 2020 compared to 2010. But the specialists see it as an effect of the Covid epidemic and the barrier gestures which have limited
infections.

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