Antibiotic resistance. Newborns are also at risk: 214,000 deaths from antimicrobial-resistant infections every year in the world


The figure was illustrated today by the Italian Society of Neonatology. About half of the pathogens causing severe neonatal infections are currently resistant to first- and second-line treatments recommended by the World Health Organization. The Sin president, Luigi Orfeo: “The picture that emerges is that of a reality in which the arsenal to fight microorganisms is increasingly poor in means”.

21 NOV

In recent years, the phenomenon of antibiotic resistance (AMR) has considerably worsened, becoming one of the major global threats. There is a risk that common infectious diseases can once again become difficult to treat and therefore fatal. Italy, together with Greece and Portugal, is among the countries with the highest mortality rates from AMR, according to the latest report by the Organization for Economic Co-operation and Development (OECD). In our country, the proportion of antibiotic-resistant infections rose from 17% in 2005 to 30% in 2015 and could reach 32% in 2030, much higher than the OECD average.

The alarm comes from the Italian Society of Neonatology (Sin) during the World Antimicrobial Awareness Week – WAAW, 18-24 November.

What worries Italian neonatologists is the phenomenon of antibiotic resistance in newborns, i.e. the adaptation of microorganisms to the environment, which determines the reduction or elimination of the efficacy of an antimicrobial agent. Although it is a natural mechanism, explains Sin, the main factors, both of its development and of its diffusion, are “artificial” and due to man and in particular to the inappropriate and excessive use of antibiotics, not only among humans, but also among food-producing animals.

Furthermore, the global dimension of the problem depends on the fact that once a pathogen develops resistance to an antibiotic, this resistance spreads very rapidly throughout the world, fueled by population mobility and globalisation.

In the neonatal setting, there has been growing evidence of infections due to antibiotic-resistant pathogens in recent years. Neonatal sepsis due to these pathogens is associated with significantly higher rates of sequelae and mortality. Globally, it is estimated that 214,000 deaths of newborns each year are attributable to antibiotic-resistant microorganisms. About half of the pathogens causing severe neonatal infections are currently resistant to first- and second-line treatments recommended by the World Health Organization.

In fact, antibiotics are the most commonly used drug in Neonatal Intensive Care Units (NICU), accounting for one third of the top 10 most commonly used drugs in NICU. Unfortunately, even though neonatologists have begun to critically evaluate the use of antibiotics in recent years, the challenge of optimizing their use in the neonatal setting remains significant.

Even now, recalls Sin, more than 75% of newborns weighing less than 1,500 g and more than 80% of those weighing <1,000 g are subjected to antibiotic therapy at birth, in the suspicion of sepsis, despite being reported in literature an incidence of early sepsis ranging from 0 to 7%. Recent literature data also show that unnecessary and prolonged use of antibiotics during the first week of life in preterm infants increases the risk of onset of late infection, necrotizing enterocolitis or death.

According to the report of Global Research on Antimicrobial Resistance published in 2022 by The Lancetwhich analyzed data from 204 countries, in 2019 more than 1.2 million people died from infections caused by bacteria resistant to various antibiotics, and about 5 million deaths are associated with AMR phenomena.

Previous estimates published in Review on Antimicrobial Resistance of theUK Department of Health they predicted, by 2050, 10 million deaths annually from bacterial infections with resistant pathogens. However, the data of the report published on The Lancet they indicate that we are much closer to this figure than previously thought.

Beyond the health impact, AMR also has an economic impact that, according to the World Bank, could be worse than the 2008-2009 financial crisis. There Review on Antimicrobial Resistance estimates the costs from AMR by 2050 at about $100 trillion, however, the OECD report reports that addressing the complications of AMR could cost up to $3.5 billion a year on average across the 33 countries analyzed and 13 billion dollars in Italy until 2050.

“The strategies to be implemented, to stem this silent pandemic in neonatology, are no different from those proposed for the general population”, says the President of the Italian Society of Neonatology (Sin), Louis Orpheus. “The picture that emerges is that of a reality in which the arsenal for fighting microorganisms is increasingly poor in resources. The new antibiotics will not permanently solve the problem, because they will lose their effectiveness after a certain period of use due to resistant bacteria. The most important tool for limiting AMR is prevention in hospitals, through the correct use of antibiotics and infection prevention and control strategies, first of all hand hygiene, which should continue to be strongly encouraged. Every hospital should adopt an “Antibiotic Stewardship Program”, with the formation of a multidisciplinary team that guides doctors in the conscious use of antibiotics. If adequate action is not taken immediately, we run the risk of finding ourselves in the pre-antibiotic era of the 1930s and in a world without antibiotics”.

November 21, 2022
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