It seems obvious that among the health advances of the last century have been the discoveries of different families and generations of antibiotics 1. These drugs have helped to save millions of lives and their impact on infection control across the globe is undeniable 2. At the same time, the threat of the progressive emergence of microorganisms resistant to them has become one of the most obvious challenges for those of us who work in the field of health3. It is precisely on the union of efforts in the fields of human, animal and food health that, according to the experts, the future success in tackling this health problem depends: antibiotic resistance4. There is an urgent need to increase our level of awareness on the subject, to invest in strong continuous education among professionals, in dissemination campaigns among the population, and to adopt efficient measures for its control5. Since the beginning of the last decade, there are contributions that established that if no action is taken, antibiotic resistance will undermine the welfare state and will constitute a problem whose evolution may become an uncontrollable challenge6.
In our experience there are three lines of work that have allowed us to maintain an active stance in the rational use of antimicrobials. Firstly, the implementation of studies on variability in prescription and consumption, carried out in specific health areas in different Autonomous Communities, may periodically represent a valid instrument to identify areas for improvement7,8. Both in the paediatric area 9, and in the adult area 10-12 inadequate practices have been observed that point to simple and easy corrective measures.
In the second place, and from the framework of the activity of the Microbiology Services, an active stance should be adopted that offers updated profiles and sensitivity, within the reach of prescribing clinicians, and which in the last decade has been integrated into the framework of activities of the commissions of the Rational Antimicrobial Optimization Programs (PROA)13. Of particular relevance is the usual role played by the field of microbiology in detecting outbreaks14, monitoring the appearance and spread of multi-resistant microorganisms15 and transmitting a prescribing "culture" based on the native ecosystem.
Thirdly, we must make a firm commitment to incorporating technology into the healthcare and applied research environment that will make it possible to identify the molecular mechanisms that make it possible to identify and monitor the transmission of resistance, such as mass sequencing and the development of bioinformatics platforms to support it16,17. To this we should add the need to advance in the knowledge of the physiological environments of the microbiota and its role in the establishment of numerous clinical entities in which we have also been able to make a modest contribution18.
We cannot ignore our involvement in an interdisciplinary framework to align ourselves with international organizations and movements that are committed to "one health" 19-20. Only from our capacity for dialogue, joint work and the sum of our experiences can we contribute to minimizing the negative impact that antimicrobial resistance has in our planet's ecosystem.
1.- Abbas M, Paul M, Huttner A. New and improved? A review of novel antibiotics for Gram-positive bacteria. Clin Microbiol Infect. 2017; 23: 697-703.
2.- Ahmad M, Khan AU. Global economic impact of antibiotic resistance: A review. J Glob Antimicrob Resist. 2019; 19: 313-316.
3.- Frieri M, Kumar K, Boutin A. Antibiotic resistance. J Infect Public Health. 2017; 10: 369-378.
4.- Tyrrell C, Burgess CM, Brennan FP, Walsh F. Antibiotic resistance in grass and soil. Biochem Soc Trans. 2019; 47: 477-486.
5.- Gyssens IC. Role of Education in Antimicrobial Stewardship. Med Clin North Am. 2018; 102: 855-871.
6.- Davies J, Davies D. Origins and evolution of antibiotic resistance. Microbiol Mol Biol Rev. 2010; 74: 417-433.
7.- Pinilla Sánchez JM, Eiros Bouza JM, Arahuetes Benito F, Vega Quiroga S, Moreno Sánchez E. Consumo de antibióticos en la población general del área de Segovia durante el período 1999 a 2007. Rev Esp Quimioter. 2011; 24 99-106.
8.- Sánchez-Núñez ML, Vallina-Victorero MJ, Bachiller-Luque MR, Pinilla Sánchez JM, Eiros JM. Análisis del uso ambulatorio de antibióticos en los hospitales generales de Asturias entre 2006 y 2015. Rev Esp Quimioter. 2018; 31: 27-34.
9.- Vázquez ME, Eiros JM, Martín F, García S, Bachiller RM, Vázquez MJ. Prescripción de antibióticos a la población pediátrica de Castilla y León en la última década: tendencias, fluctuaciones estacionales y diferencias geográficas. Rev Esp Quimioter. 2012; 25: 139-146.
10.- Vázquez ME, Pastor E, Bachiller MR, Vázquez MJ, Eiros JM. Variabilidad geográfica de la prescripción de antibióticos en la población pediátrica de Castilla y León durante los años 2001 a 2005. Rev Esp Quimioter. 2006; 19: 342-348.
11.- Pastor E, Eiros JM, Mayo A. Evolución del consumo de antibióticos en España. Med Clin (Barc) 2003; 120: 78. doi:10.1016/s0025-7753(03)73605-7.
12.- Álvarez M, Pastor E, Eiros JM. Social and demographic determinants in the prescription of systemic antibiotics. Infez Med. 2012; 20: 37-48.
13.- Horcajada JP, Grau S, Paño-Pardo JR, et al. Antimicrobial stewardship in Spain: Programs for Optimizing the use of Antibiotics (PROA) in Spanish hospitals. Germs. 2018; 8: 109-112.
14.- de Frutos M, López-Urrutia L, Domínguez-Gil M, et al. Serratia marcescens outbreak due to contaminated 2% aqueous chlorhexidine. Brote de Serratia marcescens producido por clorhexidina acuosa al 2% contaminada. Enferm Infecc Microbiol Clin. 2017; 35: 624-629.
15.- Hernández M, Quijada NM, Lorente LL, de Frutos M, Rodríguez-Lázaro D, Eiros JM. Infrequent isolation of extensively drug-resistant (XDR) Klebsiella pneumoniae resistant to colistin in Spain. Int J Antimicrob Agents. 2018; 51: 531-533.
16.- Quijada NM, Rodríguez-Lázaro D, Eiros JM, Hernández M. TORMES: an automated pipeline for whole bacterial genome analysis. Bioinformatics. 2019; 35: 4207-4212.
17.- Hernández M, Quijada NM, Rodríguez-Lázaro D, Eiros JM. Aplicación de la secuenciación masiva y la bioinformática al diagnóstico microbiológico clínico. Rev Argent Microbiol. 2020; 52: 150-161.
18.- Hernández M, de Frutos M, Rodríguez-Lázaro D, López-Urrutia L, Quijada NM, Eiros JM. Fecal Microbiota of Toxigenic Clostridioides difficile-Associated Diarrhea. Front Microbiol. 2019; 9: 3331.
19.- McEwen SA, Collignon PJ. Antimicrobial Resistance: a One Health Perspective. Microbiol Spectr. 2018;6(2):10.1128/microbiolspec.ARBA-0009-2017.
20.- Harrison S, Kivuti-Bitok L, Macmillan A, Priest P. EcoHealth and One Health: A theory-focused review in response to calls for convergence. Environ Int. 2019; 132: 105058.