Between January and October of this year, over 3,700 samples of antibiotic-resistant bacteria were identified by the Hospital Infection Research Laboratory of the Oswaldo Cruz Institute (IOC/Fiocruz). This number of superbugs — as infectious agents that resist common medications are called — is three times greater than that recorded in the pre-pandemic period of covid-19, during 2019.
In 2019, just over a thousand cases of superbugs were referred, by different Brazilian public health laboratories, for complete analysis by Fiocruz and, later, confirmed as agents resistant to antibiotics.
In 2020, the first year of the covid-19 pandemic, the number of positive samples rose to almost 2,000, which also drew attention. The increasing trend in superbug records reinforces a concern among specialists: during the emergence of covid-19, there is also an increase in the spread of microorganisms capable of resisting different antibiotics, which can pose a risk to public health.
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“We cannot specify the dimension of the problem at the national level, but it is important to act and this has been reinforced by Anvisa [Agência Nacional de Vigilância Sanitária]”, comments the researcher and head of the Hospital Infection Research Laboratory, Ana Paula Assef. In this sense, the challenge can be even greater.
It is worth explaining that this Fiocruz analysis center acts as a back-up laboratory of the Microbial Resistance Analytical Sub-network in Health Services (Sub-network RM), established by Anvisa and the Ministry of Health (MS).
Antibiotics only act against bacteria
One of the reasons why resistant bacteria have become more common is the excessive use of antibiotics. “There are bacteria living in our bodies, animals and the environment. Whenever we use antibiotics, in healthcare facilities, at home or in agriculture, we increase the selective pressure on these microorganisms. This speeds up the emergence and spread of resistance, as the bacteria manage to transmit the resistance mechanisms to each other”, explains Assef.
With covid-19, prescriptions for these drugs grew dramatically and allowed the bacteria to become more resistant. “In part, the increase in antibiotic prescriptions in hospitals during the pandemic can be explained by the greater number of critically ill patients hospitalized, who end up developing secondary infections and needing these drugs. However, excessive use needs to be controlled to avoid boosting the bacterial resistance”, he reinforces.
After all, covid-19 is caused by a virus. And viruses can be fought with antivirals, such as the potential Molnupirvir, from MSD drugmaker. The use of antibiotics is restricted to bacteria and does not work as a prophylaxis against the coronavirus, for example. Another risk is the individual who starts the treatment, but abandons it before the end, allowing some bacteria to resist in their body.
“An antibiotic cannot be taken by an acquaintance or family member. For these medications to remain effective, they must be used judiciously, with a prescription only. The patient needs to follow the prescription unrestrictedly, with the exact amount of dose and duration of administration”, reminds the microbiologist.
Superbacteria and high mortality
In August of this year, Anvisa published a technical note with guidelines for preventing and controlling the spread of resistant bacteria in health services in the context of the pandemic. The text reinforces that, in the covid-19 scenario, antibiotics are only recommended for cases with suspected bacterial infection associated with viral coronavirus infection.
Furthermore, it is important to explain that infections caused by resistant bacteria are generally associated with high mortality, as there are no effective drugs for most treatments. The note also highlights an outbreak recorded in an Intensive Care Unit (ICU) in Maringá, Paraná. At the site, ten patients hospitalized by covid-19 infected by bacteria A. baumanii resistant to carbapenem antibiotics, seven died from the infection.