Beware of the insidious pandemic! "We may even lose patients who can receive outpatient treatment."
Antibiotics are described as "magic bullets" in the fight against bacteria and are considered the most remarkable medical discovery of the 20th century. The greatest threat, "antibiotic resistance," arises when bacteria develop defenses against antibiotics designed to kill them and struggle to survive. When resistance to an antibiotic develops, treatment requires different antibiotics, which may be less effective or have more side effects. Sometimes, bacteria can resist all available antibiotics. When this happens, patients with infections caused by these bacteria are left without treatment options. Furthermore, it's important to remember that resistant bacteria can spread to others in healthcare settings or at home.
IF NO PRECAUTIONS ARE TAKEN, THERE WILL BE 10 MILLION DEATHS PER YEAR IN 2050Prof. Dr. Ümit Savaşçı, a faculty member in the Department of Infectious Diseases and Clinical Microbiology at SBU Gülhane Training and Research Hospital, answers the questions, "How aware are we of the threat that antibiotic resistance poses and will pose globally? Are we running at full speed toward the abyss as a result of our unawareness of this problem?" Antibiotic resistance is a global problem. Turkey remains a leading country in both antibiotic resistance and its use. According to data from the Organization for Economic Co-operation and Development (OECD), our resistance rate has increased from 38.1 percent to 46.5 percent in the last five years. Our forecast analysis indicates that the burden on the healthcare system due to antibiotic resistance will increase in the coming decades, with a 67% increase in deaths between 2022 and 2050. According to World Health Organization (WHO) data, the number of deaths worldwide due to antimicrobial resistance is around 700,000 per year. If no action is taken, this number will rise to 10 million per year by 2050. This means we will be facing a pandemic every year that could cause many more deaths than the Covid-19 pandemic, which has affected the entire world for four years.
As a result, prolonged, intensive antibiotic use can lead to serious liver and kidney failure, allergic conditions, and neurological and cardiovascular health problems. Furthermore, antibiotics act like an atomic bomb, killing beneficial probiotic microorganisms in the gut and causing irreversible, permanent damage to all systems for years. It's been noted that the rise in immune system damage, diarrhea, constipation, and rheumatological, neurological, and allergic conditions indicates that people are constantly battling illness.
RATIONAL USE SHOULD BE ENCOURAGEDAccording to a World Bank report, antimicrobial resistance is estimated to cause a global economic loss of $100 trillion by 2050. A report by the Turkish Economic Policy Research Foundation indicates that if current resistance levels in Türkiye persist for years, the economic loss will reach $1.4 trillion between 2010 and 2050. It is noted that world health authorities and developed countries are preparing preventative measures, and that the WHO developed the AWaRe (Access, Watch, and Reserve) system in 2017 to standardize the use of antibiotics and encourage their rational use. It is noted that those implementing systems designed to monitor antibiotic prescribing habits, slow the development of resistance, and preserve effective treatment options have achieved effective results. Developed countries, particularly Finland, the UK, Sweden, Switzerland, the Netherlands, and France, have achieved success by fostering collaboration between healthcare professionals and the public.
Prof. Dr. Umit Savasci; Turkey has the second-highest antimicrobial resistance rate among countries with available data. It also ranks among the highest in the world in terms of antibiotic consumption. Due to this relationship, Turkey is among the countries with the highest potential for increasing resistance rates in the coming period. For all these reasons, antimicrobial resistance poses a significant threat to Turkey and has brought our country to the forefront of global discussions. In recent years, policies and programs aimed at reducing antibiotic use rates have been at the top of Türkiye's health agenda. Relevant public institutions are conducting numerous studies on this issue, and the planned policies are being rapidly implemented. In addition to existing efforts, the creation of a detailed and representative antimicrobial resistance map covering both medical and livestock practices stands out as a priority. As stated in the G20 Hamburg Leaders' Declaration, focusing on R&D in countries like Turkey, which require prioritized efforts to combat resistance, is of paramount importance. To this end, a national antimicrobial resistance surveillance system was established in 2011 within the Ministry of Health. Our country is also participating in the "Medium Resistance Research and Development" project conducted by the WHO European Office. It is a member of the Asian and Eastern European Antimicrobial Resistance Surveillance Network (CAESAR). In light of this data, compared to the European average, resistance rates to various antibiotics in common and problematic bacterial infectious agents have unfortunately reached four to five times the rate in our country.
*Incorrect or unnecessary use: Antibiotics only treat bacterial infections and are ineffective against other pathogens, such as viruses. However, when used frequently (or given unnecessarily) for viral infections (e.g., colds and flu), the risk of developing resistance increases.
*Failure to follow dosage instructions: Failure to follow dosage instructions or not completing the course of treatment may lead to the development of resistance.
*Antibiotic use in agriculture and livestock farming: Antibiotics, commonly used in animal husbandry and agriculture, can spread resistant strains of bacteria into the environment and food. This can increase the risk of human exposure to resistant bacteria.
*Poor hygiene practices: Failure to comply with hand hygiene and general hygiene rules can lead to the spread of infections and increased antibiotic use.
*Lack of global and community collaboration: Because this is a global problem, international collaboration is crucial for effective management. However, lack of coordination and differing antibiotic use policies across countries can exacerbate problems.
Prof. Dr. Ümit Savaşçı SOLUTION SUGGESTIONS AND LAST WARNINGThe outcome of antimicrobial treatment must be predictable and personalized. To enable authorized healthcare professionals to take protective and preventative measures, they must have access to the most accurate data and methods in the fastest and easiest way possible. This is only possible through AI-powered software developed jointly by medical doctors and software engineers that analyzes patient data (personal data, medical images, laboratory results, electronic records, etc.) and the disease (type, incidence, and other relevant parameters).
To control and manage antimicrobial resistance, coordinated coordination and collaboration are required at national and international levels within and across multiple sectors, including pharmacy, agriculture, finance, trade, education, and the healthcare industry, including civil society organizations. It is crucial to curb doctors' tendency to prescribe broad-spectrum antibiotics for minor conditions and to closely monitor veterinarians' use of antimicrobials for animals. Overall, the fight against this disease requires rational antibiotic prescribing, limited use of antimicrobials, and emphasis on patient education. Encouraging sustainable investment in new drugs, diagnostic tools, and vaccines is also essential. Professor Ümit Savaşçı says, “Currently, our hands are tied when it comes to life-threatening infections like sepsis. It would be a tragedy if patients we could easily treat as outpatients in outpatient clinics lost their lives. While antimicrobial resistance is a silent pandemic, it is a crisis we cannot remain silent about. This is our final warning.”
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