Antibiotic courses are often associated with treating bronchitis, traveller’s diarrhoea and other fairly common diseases. In addition, surgery is among the activities dependent on efficacious antibiotics, as they are used to treat infections potentially caused by surgical procedures. Even now, in a pandemic that is plaguing the world, the effectiveness of antibiotics is important. Although COVID-19 is a viral disease, a significant proportion of deaths are associated with bacterial sequelae.
But what if antibiotics become ineffective in the future?
Antibiotic resistance means bacteria that are resistant to antibiotics. The harm caused by their spread has even been compared to the threat posed to humanity by climate change.
Already now, hundreds of thousands of people die every year globally because of antibiotic resistance. According to the European Centre for Disease Prevention and Control, such fatalities also occur in Finland.
If the prevalence of this trait cannot be curbed, the figure can raise up to 10 million per year by 2050, which would make bacteria resistant to antibiotics more lethal to humans than cancer.
Science is fighting against the spread of antibiotic resistance, for example, by developing new types of antibiotics and vaccines. Another way is to gain a better knowledge of how and in which conditions resistant bacterial strains are born.
This is the focus of Marko Virta and his research group at the Department of Microbiology, University of Helsinki.
Water treatment plants are research targets
Instead of clinical laboratories, Virta is investigating resistance to antibiotics in environments connected with human activity. Among the common factors that have an impact on the spread of antibiotic resistance are societal conditions, such as wastewater treatment, the availability of clean water and the functionality of government.
“This is why an approach based solely on natural sciences or engineering does not solve the problem. Instead, we need highly multidisciplinary expertise.”
In the StARE (Stopping Antibiotic Resistance Evolution) research project, Virta and his group are investigating 11 randomly selected wastewater treatment plants in northern and central Europe. The plants are favourable environments for studying resistance, as the human waste that ends up in them brings with it both pathogens and antibiotics. This is because a large portion of antibiotic courses are secreted in urine.
Theoretically, water treatment plants could, at their worst, serve as ‘superbacteria incubators’. These plants provide opportune conditions for two mechanisms through which bacterial resistance evolves: selection pressure and the spread of resistant genes.
“Selection pressure is the notion originating with Charles Darwin, according to which antibiotics use will eventually result in the survival of resistant bacteria. When drugs are used, the bacteria sensitive to them are eradicated, after which the entire bacteria population of the human intestinal tract becomes resistant.”
As bacteria resistant to antibiotics are transmitted between individuals, the prevalence of resistance increases. This, in turn, results in antibiotic courses becoming ineffective against infections.
Bacteria previously sensitive to antibiotics can develop resistance also by acquiring resistance genes from other bacteria. This could occur, for example, in a water treatment plant where bacteria meet, after which resistant bacteria would spread further.
Fortunately, the share of resistant bacteria among all bacteria was reduced after water purification in the majority of the plants included in the study.
Alarmingly, this is not guaranteed, which is why antibiotic resistance must be further investigated.
Treatment with narrow-spectrum antibiotics
A straightforward edict to avoid unnecessary antibiotics use does not by itself solve the resistance issue.
“Of course, the unnecessary use of antibiotics should be stopped. But they have a multitude of genuine uses. In the Nordic countries, massive reductions in use are not even possible,” Virta notes.
Globally, the fact that poor people in need of antibiotics cannot necessarily gain access to them constitutes a converse problem.
Even though taking antibiotics increases bacterial resistance, drug consumption figures alone do not affect its increasing prevalence. For instance, fewer bacterial strains resistant to antibiotics occur in Canada and Ireland than in Finland, even though antibiotics are used to the same degree in the three countries in proportion to their populations. The development of resistance is also influenced by the types of drugs used.
There are both narrow-spectrum and broad-spectrum antibiotics in use, the latter being effective against several bacteria. To avoid the onset of resistance, pathogens should be fought with drugs of as narrow a spectrum as possible, or drugs designed for specific diseases, but this is not the practice everywhere.
Additional funding for long-term research in Asia and Africa
In addition to drug use, the movement of people also has an impact on the spread of antibiotic resistance. Many Finnish travellers return from South-east Asia with resistant superbacteria, particularly those travelling to India. Finns cannot afford to close their eyes to this problem.
“Finland could follow the example of Sweden, as Swedes consider themselves more of a global force than Finns. If there’s a problem somewhere in the world, they think it also concerns them,” Virta says.
For example: A joint EU call for funding applications for research projects in the field of microbiology is currently open. Finland is contributing €850,000 to this future research, while Sweden's share is €2.9 million.
Virta demands the allocation of funding for research focused on resistance to antibiotics specifically outside Europe. If such studies are only conducted in Europe, the results easily become skewed. Funding is particularly needed for projects targeted at Asia and Africa. According to Virta, that is where problems caused by antibiotic resistance are greater than in the West.
“Metropolises and the less urban surrounding regions should be investigated much more. This requires not only sufficient funding but also enough time. Instead of two years, research projects could last, say, five years.”
The acquisition of funding takes time, making longer funding periods a guarantee of an increased focus on the research itself.
“One option is to award a certain group funding for its activities for five years with a single application. Currently, such a group has to submit separate applications to gain funding for individual projects, even if the source of funding is the Finnish government.”
In Finland, both humans and production animals use fewer antibiotics than in many other countries. Virta sees this as a reason for Finland to consider becoming an active party in particular in the research on antibiotic resistance. At the same time, we could export our knowledge of antibiotics use for the benefit of others.
The spread of resistance to antibiotics cannot be entirely prevented, but if research succeeds in slowing down its increasing prevalence, savings in patient care could be achieved even in Finland.
“The spread of antibiotic resistance knows no boundaries, which makes related problems common to all. There is still time for research, but that requires opportunities and money.”