THE CHALLENGE OF ANTIMICROBIAL RESISTANCE (AMR): A GLOBAL CRISIS AND THE CRUCIAL ROLE OF PROBIOTICS

Antimicrobial resistance (AMR): a health crisis that deserves maximum attention

Antimicrobial resistance (AMR), with a particular focus on antibiotic resistance, is one of the most serious health emergencies of our time. The World Health Organization (WHO) predicts that by 2050, AMR could cause up to 10 million deaths annually, surpassing leading causes of mortality such as cancer and cardiovascular diseases. Moreover, the economic burden is staggering: AMR is estimated to cost the global economy $100 trillion by mid-century.

This global threat demands immediate and coordinated action to prevent a post-antibiotic era in which common infections and surgical procedures could once again become life-threatening.

To raise awareness about the responsible use of antibiotics and promote concrete actions against AMR, the WHO celebrates World Antimicrobial Awareness Week (WAAW) every November. In 2024, the slogan “Stop AMR: Act Now” highlights the urgency of addressing this crisis with a global approach. During this week, events and campaigns inform citizens, healthcare professionals, and policymakers about the risks of AMR and the responsible practices to combat it.

What is antimicrobial resistance (AMR) and antibiotic resistance?

AMR occurs when microorganisms such as bacteria, viruses, fungi, and parasites develop the ability to survive the drugs designed to eliminate them. Antibiotic resistance, one of the most critical forms of AMR, involves bacteria that become resistant to antibiotic therapies. This phenomenon undermines the effectiveness of treatments, making infections harder to cure, with devastating consequences for public health and the economy.

Why is AMR a global crisis?

Antimicrobial resistance has a catastrophic impact both globally and locally. According to the WHO, in 2019, there were 4.95 million deaths associated with AMR, of which 1.27 million were directly attributable to antibiotic resistance.

In Europe, 800,000 infections caused by antibiotic-resistant bacteria are reported annually, leading to over 35,000 deaths, according to the European Centre for Disease Prevention and Control (ECDC). However, Italy stands out negatively in these statistics.

Reports from the ECDC and a dossier by the Italian Medicines Agency (AIFA) highlight that Italy faces significant challenges in both antibiotic consumption and hospital-acquired infections. Antibiotic consumption in Italy exceeds the European average, and despite awareness campaigns, the trend continues to rise. This excessive and often inappropriate use of antimicrobials is one of the main factors fueling the spread of antibiotic resistance, making it increasingly difficult to treat common infections.

Regarding hospital-acquired infections, one-third of AMR-related deaths in Europe—approximately 12,000 annually—occur in Italy. During 2022-2023, 430,000 hospitalized patients contracted infections during their stay, representing 8.2% of all admissions, a figure higher than the European average of 6.5%. This imposes an annual cost of €2.4 billion on the Italian National Health Service. If this trend is not reversed, by 2050, antibiotic resistance could become the leading cause of death in Italy, surpassing cardiovascular diseases and cancer.

These alarming statistics underscore the urgency of reducing the misuse of antibiotics and improving infection prevention and control practices, especially in hospital settings.

How does antibiotic resistance develop?

Antibiotic resistance is a natural phenomenon, but it can be accelerated by human behaviors such as:

• Excessive or improper use in humans: Inappropriate prescriptions or incomplete therapies foster the selection of resistant bacteria.
• Use in intensive farming: Antibiotics are used to promote animal growth, contributing to the spread of resistant bacteria.
• Environmental spread: Resistant bacteria propagate through water, soil, and food chains.
  
  

A 2022 report identified six major pathogenic bacteria (Escherichia coli, Staphylococcus aureus, Klebsiella pneumoniae, Streptococcus pneumoniae, Pseudomonas aeruginosa, and Acinetobacter baumannii) as responsible for over 3.57 million deaths associated with antibiotic resistance.

The role of probiotics in reducing antibiotic misuse

Probiotics, live microorganisms with proven health benefits, are a valuable ally in the fight against AMR. By promoting gut microbiota balance and strengthening the immune system, probiotics can help reduce the incidence of common infections and the misuse of antibiotics.

Key Benefits of Probiotics:

1. Prevention of common infections: By lowering the risk of respiratory and gastrointestinal infections, probiotics reduce the need for antibiotics.
2. Protection during antibiotic therapy: Probiotics mitigate the side effects associated with antibiotics, such as diarrhea, and lower the risk of opportunistic infections (Clostridioides difficile).
3. Support for post-therapy recovery: They help restore microbiota balance, facilitating a quicker resolution of dysbiosis and reducing complications.
   
   

Probiotics with intrinsic safe resistance: a therapy ally

Some probiotics exhibit intrinsic natural resistance, selectively targeting one or a few specific antibiotics. One example is Bifidobacterium breve PRL2020, contained in Brevicillin®, which has shown the ability to survive high doses of antibiotics such as amoxicillin and amoxicillin + clavulanic acid. This non-transferable resistance is considered safe because it does not contribute to the spread of resistance to other pathogenic bacteria.

Furthermore, Bifidobacterium breve, known for its beneficial role in gut health, offers several advantages when integrated during antibiotic therapy:

• Protection of gut microbiota: It preserves beneficial bifidobacteria, mitigating the destructive effects of antibiotics on “good” autochthonous bacteria.
• Reduction of secondary infections: It limits the overgrowth of opportunistic bacteria that tend to occupy the space freed by the drastic reduction of beneficial bacteria caused by antibiotics.
• Accelerated recovery: It promotes microbiota balance, supporting faster and more complete recovery of intestinal health while reducing the negative impacts of antibiotic therapy.
  
  

Conclusion

Antimicrobial resistance (AMR) is a global crisis requiring an integrated and collaborative approach. Beyond the responsible use of antibiotics, innovative strategies such as the adoption of probiotics can make a significant difference. Probiotics with intrinsic, non-transferable, and proven safe resistance, like the Bifidobacterium breve PRL2020 strain in Brevicillin®, offer a tangible opportunity to protect gut microbiota, reduce complications associated with antibiotic therapies, and contribute to a healthier future for all.