Macrolide resistance after COVID-19

Medical News: A Hidden Crisis Emerging Post-Pandemic
The COVID-19 pandemic introduced unprecedented challenges in healthcare, one of which is the rise in antimicrobial resistance, particularly to macrolides like azithromycin, erythromycin, and clarithromycin. These antibiotics were used excessively during the pandemic, especially in countries like Brazil, where misinformation about their use was rampant. As we emerge from the pandemic, the medical community is confronting the unintended consequences of this overuse, which has fostered the emergence of macrolide-resistant bacterial strains, notably in hospital environments.


Macrolide resistance after COVID-19

A recent study led by researchers from the Pontifical Catholic University, Minas Gerais-Brazil, and the Federal University of Lavras-Brazil, along with collaborators from France, Saudi Arabia, and Egypt, delved deep into this issue. Their research aimed to understand the genetic, immunological, and socio-environmental implications of macrolide resistance, particularly focusing on bacterial strains from urinary tract infections (UTIs).
 
This Medical News report outlines the key findings of this important study, which highlights the growing threat of macrolide resistance and its broader public health implications.
 
Macrolide Overuse During COVID-19
During the pandemic, macrolides were widely used due to misinformation about their effectiveness in treating viral infections like COVID-19. Many individuals in Brazil, as well as across the globe, resorted to these antibiotics without proper medical guidance. This misuse was exacerbated by the lack of public awareness regarding antimicrobial resistance (AMR). The study noted that during the height of the pandemic, bacterial strains resistant to macrolides were collected from hospital environments, revealing alarming trends in antibiotic resistance.
 
The researchers focused on bacterial strains isolated from urinary tract infections, particularly those involving Staphylococcus species, which are often found in both hospital and community settings. These infections were subjected to genetic analysis, revealing the presence of resistance genes such as erm (erythromycin ribosome methylase) and msr (macrolide efflux pump) genes, which render antibiotics ineffective against these bacteria.
 
Key Findings: The Rise of Macrolide-Resistant Bacteria
The study's findings are alarming. Macrolide resistance, particularly in strains of Staphylococcus aureus, S. epidermidis, and S. saprophyticus, has become increasingly prevalent. These bacteria are common culprits of UTIs, and their resistance to treatment poses a significant challenge for healthcare providers. Infections caused by these resistant strains are more difficult to treat and require stronger or alternative antibiotics, which may not always be readily available.
 
The researchers identified several mechanisms contributing to macrolide resistance. One prominent mechanism involves mutations in bacterial ribosomes that prevent macrolides from binding effectively, allowing the bacteria to continue producing essential proteins and thereby survive treatment.
 
Additionally, resistance genes carried on plasmids (mobile genetic elements) facilitate the spread of resistance between bacteria, accelerating the problem.
 
The Gut-Brain Axis and Its Role in Resistance
One of the more surprising findings of the study was the implication of the gut-brain axis in antibiotic resistance. The gut-brain axis refers to the complex communication network between the gut microbiota and the central nervous system. Disruptions in gut microbiota, such as those caused by overuse of antibiotics, can lead to a cascade of health issues, including immunological disorders and heightened susceptibility to infections.
 
The researchers found that the overuse of macrolides not only selected for resistant bacterial strains but also disrupted the natural balance of gut bacteria. This disruption, in turn, weakened the immune system and made individuals more susceptible to infections, including those caused by macrolide-resistant bacteria.
 
The One Health Approach: Environmental and Social Factors
The study employed a One Health approach, which considers the interconnectedness of human, animal, and environmental health. Macrolide resistance is not just a human health issue but also affects animals and the environment. The researchers pointed out that antibiotics like macrolides are frequently used in agriculture, particularly in livestock. This practice contributes to the spread of resistance genes through the food chain and the environment.

The improper disposal of antibiotics in water supplies and soil further exacerbates the problem, as bacteria in these environments can acquire resistance genes and become untreatable. The study emphasizes the need for better regulation and education on antibiotic use, not only in human healthcare but also in veterinary medicine and agriculture.
 
Socio-Epidemiological Insights: Brazil’s Struggle with AMR
Brazil has been particularly affected by antimicrobial resistance, in part due to its social and economic challenges. The researchers highlighted that many people in Brazil lack access to proper healthcare and rely on over-the-counter medications, including antibiotics, without a prescription. This practice, coupled with a lack of public awareness about AMR, has contributed to the rise in antibiotic-resistant infections.
 
The study revealed that macrolide-resistant UTIs were more common in women, particularly older women, who are more susceptible to these infections. The researchers stressed the need for targeted public health interventions to educate communities about the dangers of antibiotic misuse and to promote more stringent regulations on antibiotic sales.
 
Conclusions: The Need for Immediate Action
The study concludes with a call for urgent action to address the growing problem of macrolide resistance. The overuse and misuse of antibiotics during the COVID-19 pandemic have accelerated the spread of resistance, not only in hospitals but also in communities and the environment. The researchers argue that a multi-pronged approach is needed to tackle this issue, involving stricter regulations on antibiotic use, better public education on AMR, and increased investment in the development of new antibiotics.
 
Furthermore, the study emphasizes the importance of the One Health approach in addressing antimicrobial resistance. By recognizing the interconnectedness of human, animal, and environmental health, we can develop more effective strategies to combat this global threat.
 
In conclusion, the study highlights the urgent need for coordinated action at local, national, and global levels to prevent macrolide resistance from becoming an even greater public health crisis. Failure to act now could result in a future where common infections become untreatable, leading to increased morbidity and mortality.
 
The study findings were published in the peer-reviewed journal Biomedicine & Pharmacotherapy.
https://www.sciencedirect.com/science/article/pii/S0753332224013234
 
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https://www.thailandmedical.news/news/first-novel-antibiotic-since-20-years-gepotidacin-debuts-to-treat-drug-resistance-urinary-tract-infections-utis-amidst-growing-incidences