resistance to antibiotics is inevitable. In fact, bacteria are living organisms that are capable of mutating to resist antibiotics and ” pass below the radar “. Since the discovery of penicillin in the 1940s, the bacteria are doing everything to escape from him, and the scenario is repeated in each introduction of new classes of antibiotics, such as sulfonamides, and tetracyclines historically.

today, what we are concerned about is the speed at which this resistance to antibiotics takes place. There is no longer a question of decades : sometimes only a few months after the use of new antibiotics, emerging in the scientific literature, the description of the mechanisms put in place by the bacteria to escape to new entrants.

This wide exposure creates resistance to the natural environmental.

Several reasons for this. First of all, we will pay the broken pots to use in massive and sometimes uncontrolled of antibiotics for decades, until the 2000s where there was a true awareness. This consumption frenzy regarding the use of antibiotics in humans, but also and especially in veterinary medicine for growth of livestock, in particular. It is estimated that animals are responsible for 80 % of the overall consumption of antibiotics. This wide exposure creates natural resistance “environmental” and promotes the spread of bacteria, champions of the resistance, so-called ESBL for bacteria producing beta-lactamases extended-spectrum.

another phenomenon that amplifies the transmission of these resistant bacteria : the travel ! More and more people travel the world, returning with, lurking in their digestive tract, bacteria with ready-made recipes for resist antibiotics. Revenue gained from diets are different (consumption of pork or chicken themselves contaminated, for example), following exposure to waters poorly remediated or yet to the rules of hygiene in the population, where the bacteria pass each other by manuportage. According to figures from the european Centre for prevention and control of diseases, this resistance to antibiotics continues to increase, including in France, which is now in the 6th position of the countries where antibiotic resistance is high (1), sad record.

Despite the various national plans of health authorities which have succeeded each other since the late 1990s to combat antimicrobial resistance, to this day, the consumption of antibiotics cannot be deflected sufficiently to allow a control of these multidrug resistant bacteria (BMR), including these enterobacteria resistant to the above-mentioned (ESBL). They are spreading rampant in the hospital, but also not exceptional in the city. Some experts even say that resistance to antibiotics is able to continue its ascent even if it contains the consumption of antibiotics in the world. This requires to act upon other levers, to have strategies other than to simply reduce the use of antibiotics. It would be necessary to address, for example, sanitation of drinking water resources (2), to consume differently with a feed from organic farming production better controlled and also better detection of patients carrying resistant bacteria, to better isolate them in the hospital and reduce the risk of secondary transmission.

there is a mismatch between supply and demand to combat these multidrug resistant bacteria.

But some experts are beginning to wonder whether it might not be better to stop trying to identify everyone, because the thresholds of the management capacity of the isolation of the sick will eventually be exceeded, which could lead to an unequal treatment of patients. When this balance is reversed, in some countries, such as Israel or the netherlands, you can even choose to isolate patients non-carriers of resistant bacteria to protect them from others !

You should know that in order to fight against these notorious multidrug resistant bacteria, there is a mismatch between supply and demand. In fact, since the beginning of the millennium, we observe a dramatic decrease in the populations of staphylococcus aureus resistant to penicillin, commonly known as MRSA in the medical jargon, because of better hygiene with hand washing and the widespread use of the aqueous solutions, hydro-alcoholic in the hospital, while at the same time the populations of bacteria of type ESBL explode. Therefore, we should have especially antibiotics against them. However, since the beginning of the millennium, the market of the drug is mainly with antibiotics effective against… the MRSA. To simplify, we can say that, now that we have much less need of them, and it was full. While in all only three small molecule anti-ESBL have seen the light of day in twenty years. The reason is simple : as always, what are the needs in the United States that condition the arrival of new medicines and, in addition to-Atlantic, more than 50% of staphylococci are resistant, including in the city.

The anti-MRSA are so popular. Why so much resistance in them ? It is the result of a use of antibiotics even more stupid than we are : by under-dosing antibiotics, instead of typing hard on the bacteria, they were selected more resistance. As a bonus, this new arsenal does not accept any new class of antibiotics to speak of. It is not that enhancements of molecules already available on the market since the 1990s, which have been made a few adjustments to chemicals, history of make up in part for the resistance to antibiotics developed in the meantime. in Short, it has always been a train delay.

But we are fortunately not completely dry : there is a reference treatment against these ESBL. It is a family of antibiotics, the carbapenems, are reserved to hospital use and administer by the intravenous route. However, the use of these molecules contributes to increase the resistance of bacteria, the worst of which are called “superbugs” by the Anglo-Saxon countries, highly resistant bacteria emerging, it is said by scientists in France. They are somehow a notch above the resistant bacteria that were discussed earlier and lead us to antibiothérapies extremely complex, or even non-existent. Fortunately, a situation very rare.

He should really strive to contain the spread of antibiotic resistance.

So, what is this that awaits us in the years to come ? The nature has horror of the vacuum, this phenomenon of resistance to antibiotics is inevitable and will continue as long as we have not found alternative strategies or classes of antibiotics with new mechanisms of action. Some tracks are in the study, such as that of phages – viruses that target bacteria – or the transplantation of microbiota fecal to replace the intestinal flora and, therefore, the bacteria that can be found.

Read also Benjamin Davido – The weapon fecal, the return !

In the meantime, the recent antibiotics against multi-drug resistant bacteria (approximately 2 000 to 3 500 euros per week) are subject to strict regulation. Their prescription depends on a hospital pharmacist and an expert in infectious diseases physician. They are administered after biological tests specific to avoid any drift of use an escalation of resistance and emergence of ” superbugs “. He should really strive to contain the spread of antibiotic resistance, which currently is to be found not only in hospital but also in town ( < 5 %) (3), because it is the site of 90 % of all prescriptions of antibiotics. The physicians of the city should be better trained to just prescription in the antibiotic treatment. For example, we know that in the respiratory infections, which represent the first sector of consumption antibiotic according to the MSNA, three days of antibiotic treatment is sufficient in the majority of cases, if the patient is well and has no fever (4).

* Benjamin Davido physician-scientist in the division of infectious diseases of the Hospital Raymond Poincaré in Garches.

1. Cassini, et al, Lancet Infec dis. Nov 05, 2018

2. Collignon et al, Lancet Planet Health. 2018 Sep;2(9) : e398-e405

3. Nicolas-Chanoine et al, J Antimicrob Chemother. 2013 Mar ; 68(3):562-8.

4. Dinh et al, Clin Infect Dis 2018 Jun 1 ; 66(12):1981-1982.

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