In Europe, resistant bacteria kill 35,000 people every year

Bacteria adapt easily if they dislike the environment, such as when exposed to antibiotics

35,000 people die from antibiotic resistant bacteria every year in Europe and the number is rising. This emerges from a recent report by the European Center for Disease Prevention and Control (ECDC). Some scientists fear that by 2050 more people will die from resistant bacteria than from cancer. Can we go back in time? Heiman Wertheim, head of the Department of Medical Microbiology and head of the Infectious Diseases Center at Radboud University Medical Center, answers five questions about resistance.

How do resistant bacteria arise?
‘Bacteria adapt easily if they don’t like the environment, for example when exposed to antibiotics. Then they change their DNA. They harvest genes from the environment or modify their own genes. Such a change can help you cope with the antibiotic. For example, it ensures that the antibiotic’s target spot changes, or that bacteria can break down the antibiotic or pump it out of the cell, so no damage occurs. Bacteria can also pass on those DNA changes. Resistant bacteria have an advantage when a patient is given a course of antibiotics. The patient will not get better then.’

What does this mean for society?
‘We are facing great challenges. Due to globalization, resistant bacteria spread more easily. An aging population, cuts, staff shortages and the coronavirus pandemic are putting pressure on healthcare. We know that a growing demand for assistance leads to greater resistance problems. Due to their workload, healthcare workers are less able to comply with all infection prevention measures. Resistance can be prevented with good hygiene, such as hand hygiene, targeted diagnostics and the use of the right antibiotic. You have to keep investing to keep that foundation in order. Make sure there are enough hands at the bedside, microbiologists, infection prevention experts and infectious disease specialists. And we need to stay proactive, come up with clear guidelines and implement them correctly. It’s doing quite well in the Netherlands, but Southern Europe is not investing in that. If we don’t continue to eliminate resistance, we risk more deaths from resistance than from cancer by 2050, according to a UK government study. It doesn’t seem like an unlikely scenario to me.”

How is the situation in different countries?
‘In Northern European countries, including the Netherlands, the problems are relatively small because we have a strong healthcare chain. We have a good infrastructure with clear protocols and we are proactive. However, this is now under pressure. In Europe, the problems are concentrated in the Mediterranean region, such as in Italy and Greece. Outside of Europe, we see the greatest resistance in Asia, especially India. Prevention does not receive the right attention in these areas and there is a lack of policies and a sensible approach. Antibiotics are available everywhere and are used haphazardly, even if they don’t work at all for a patient.’

Are we still developing new antibiotics?
‘We need to change the revenue model for antibiotic development. If a company develops a new drug that costs a lot of money, we initially put it on reserve as a reserve. We are wary of new drugs, precisely because of that resistance. Also, you usually only use antibiotics for a short time. As a result, companies do not recoup their investment in antibiotics. While they are needed in the context of public health. The government should actually pay manufacturers to develop antibiotics. This is already happening to some extent, but it is still very difficult for companies. Fortunately, however, some new resources are becoming available and we are using them more and more often.’

What can we do to reverse the trend?
‘We can prevent resistance with good organization of prevention, diagnostics and the right treatment. This addresses the root problems. We will also continue to conduct research, for example on the spread of resistance, accelerating diagnostics and new medicines. It is very important to share our knowledge with countries that are not doing so well. For example, at the Center for Infectious Diseases we organize training courses for health professionals from abroad. They are assigned a mentor, who helps them apply their newly acquired knowledge after their return. Also, we can all be mindful of hygiene, and it’s good that we hold each other accountable.’