Hospital infections are no longer exclusive to hospitals


When Alexander Fleming discovered penicillin in 1928, which made it possible to cure many microbial diseases and save millions of lives, no one suspected that this response would be reconverted to a new challenge in the 21st century.

The World Health Organization says that antimicrobial resistance today is a real problem on a global scale. It is that the bacteria also evolve and that the selection makes these microorganisms acquire resistance to the medicines to those who were originally vulnerable.

Therefore, it is not enough to develop new drugs, because the bacteria, through the process of selective pressure, will always find a way to become resistant and to stop responding to the common treatment, which can lead to prolonged diseases with greater risk of death

The WHO estimates that every year about 700,000 people die worldwide because of this cause and that if no action is taken, that number will reach 10 million by 2050. "Change can not wait. of antibiotics is over, "was one of the latest communications from the world health organization.

He also explained that the misuse and systematic abuse of these drugs in medicine and food production put all nations at risk. There are few new substitution antimicrobials in the research and development phase. Without harmonized and immediate measures around the world, progress is being made towards a post-antibiotic era in which common infections could once again become deadly.

This concern of the scientific community grows day after day, since the rate of resistance to molecules with antibiotic action is very high, which impacts on the mortality and morbidity of patients, mainly those who work in the community. and may contract some "health care-associated infection" (formerly called hospital or nosocomial).

The change of denomination arises from a new paradigm: due to the changes made in the care modalities, we find patients attended with multiple procedures, not only in the hospital, but also in day hospitals, geriatric hospitals and home hospitalizations.

Experts at the VIII Congress of the Argentine Society of Bacteriology, Mycology and Clinical Parasitology (SADEBAC) explained that the focus of the problem is not only in the hospital and sanatorium, but also includes health centers such as day hospitals, geriatric hospitals and home hospitalizations.

This represents a new paradigm at the global level, where human, animal, and environmental health are interrelated, and involves an interconnection of germs between the three.

"These health care-associated infections (SIGIs) are closely related to the use of medical devices that we did not have before, medicine has progressed tremendously, which is why there are now more patients with compromised immune systems (transplant, oncology, etc.) often exposed to invasive procedures that inevitably carry the risk of acquiring infections associated with their use, "said Dr. Jaime Kovensky Pupko, a biochemist, specialist in clinical bacteriology at the UBA and coordinator of the Subcommittee of the Argentine Antimicrobial Society of Bacteriology, Mycology and Parasitology Clinical (SADEBAC).

In this area, one of the issues that most concern the scientific community is the low rate of adherence to handwashing of health personnel, which in our country does not exceed 30%.

"The biggest problem of not washing hands is the horizontal transmission of bacteria," said Dr. Adriana Sucari, biochemist, vice president of the Argentine Association of Microbiology (AAM) and president of SADEBAC. "Doctors, nurses, kinesiotherapists and all health professionals who help a patient who has a resistant bacterium can spread it to the next patient if they do not wipe each other's hands," he added.

One of the actions that tend to contain the advancement of multiresistant bacteria is to decrease IACS. Experts agree that there is much that can be done to minimize the rate of infections associated with health care.

"Each medical institution should design and implement a surveillance program that includes the search for carriers of multidrug resistant bacteria and the application of standard precautions and contact isolation to avoid horizontal transmission, which occurs from one patient to another, or generally through hands of the attending staff and use of inanimate objects such as stethoscopes, thermometers, etc. Hand washing is one of the standard precautions, the rest are the use of gloves, masks, glasses and gowns, "says Kovensky.

The acceleration observed in recent decades in the emergence and spread of antimicrobial resistance is linked to the abuse and / or misuse of antibiotics. "In 2016, antimicrobial resistance was the health issue addressed at the United Nations Summit of Presidents." For the first time, heads of state committed themselves to a coordinated and comprehensive strategy to address the issue. Key causes of antimicrobial resistance (AMR) in human health, animal health and agriculture, "noted Kovensky.

Argentina was one of the first to implement a national strategy for the control of ADR. Thus, in 2015, the National Commission for the Control of Antimicrobial Resistance (CoNaCRA) was created, in a joint act between the Ministries of Health and Livestock, Agriculture and Fisheries. This commission is composed of representatives of both ministries and official organizations with competence in the subject and the scientific societies involved in the RAM.

According to the experts gathered in CoNaCRA, the problem of antimicrobial resistance exceeds the margins of human health and represents a new paradigm created in recent years around the world. This problem states that human and animal and environmental health are the same health and that there is an interconnection of vectors between the three.

The term coined by WHO is "One Health": "An approach designed to design and implement programs, policies, laws and research in which various sectors communicate and collaborate to achieve better public health outcomes."

"This commission (CoNaCRA) is attempting to articulate different policies and actions to achieve containment of ADRs, strategies to contain resistance to antibiotics are complex and involve limiting the use of antimicrobials in animal production, especially as growth promoters, and On the other hand, an antimicrobial resistance surveillance program on animals that did not exist until now is established, "said Kovensky.

"Another of the points that is working hard with CoNaCRA is the problem of antimicrobials in the environment and particularly in water," said Sucari. "In terms of food, the use of antibiotics in the fish industry stands out because the impact is due to the fact that it is the meat that is consumed most often raw or undercooked, as in the case of sushi or ceviche."

The indiscriminate use of antibiotics and lack of cooking can lead to an increase in the intake of antibiotics and resistant bacteria.
Regarding cattle, sheep and pigs, Kovensky explained that the problem is in intensively reared animals, confined to areas where they are crowded. "In our country, this is the way to raise poultry, especially broilers or laying hens and, in a much smaller confinement or fatten a corral. "

These animals receive antibiotics as growth promoters, achieving a confrontation of the drugs with the bacteria of the intestinal microbiota of the fed ones. Bacteria, to adapt to survive in the presence of these substances, become resistant by genetic mechanisms that can be transmitted to other bacteria.

Then, when animals excrete their feces, they will be filled with resistant bacteria, contaminating the environment where they defecate and the hands of agricultural workers, and also reaching the effluents of the water, contaminating the irrigation water and the fish that develop in it. "The problem is not just the antibiotics that may be in the flesh of animals, but it includes the selection of bacteria resistant to the antibiotics we carry out in their intestines," he added.

On the other hand, experts agreed that it is necessary to work seriously in line with the regulation that already exists in the sale of antibiotics at a human level. "Antibiotics must be prescribed by a doctor and the prescription must be registered at the pharmacy, there are studies that show that noncompliance with this rule reaches 80% in the province of Buenos Aires," they emphasized.

This over-the-counter sale responds in most cases to self-medication in situations where the antibiotic is unnecessary because it is viral, and at other times the dosage or duration of treatment is inadequate, producing a selection of resistant bacteria in the infectious or in the intestinal microbiota that inhabits us. "We should all take care of the ecology of our own microbial flora if we are to contain the advance of microbial resistance," they concluded.


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