By 2050, multidrug-resistant germs will be the leading cause of death in the world. Heinz Burgmann, specialist in infections and tropical medicine, calls for more resources for the development of new antibiotics and explains how to protect against infections.
They are doctors in the Department of Infections and Tropical Medicine and are involved in a wide variety of infectious diseases. Are there any germs that you are afraid of?
Oh yes, of course. Influenza is very dangerous, for example, but also bacterial infections such as meningococci. An infection can be fatal in a matter of hours, even in healthy teens. And, of course, the world has become small and travelers can transmit viruses we know little about and against which there is no form of therapy in a very short time.
Which diseases would it be for example?
These include SARS, Severe Acute Respiratory Syndrome, and Ebola, which still circulates. But there are always new germs that we do not even know.
So, there are completely new viruses that are suddenly there?
Yes, it happens. The germs are very difficult.
With all your knowledge about infectious diseases: Can you safely recommend taking the subway?
I also take the metro myself. Because fear is always wrong. But of course, it is already necessary that everyone respects certain measures of hygiene. When you come home, washing your hands is not a luxury. Running with the disinfectant wipe all the time is useless, in my opinion.
In principle, we have a very good immune system that also wants to be challenged. This is also the problem: if we continue to function without any germ, allergies can occur more frequently. Washing hands, it is reduce germination. Because a virus or bacteria does not yet create an infection. Only a greater number of them trigger illnesses. And if you wash or disinfect your hands too often, the fat layer will also be destroyed. But it is also a protective shield. If your hands are extremely dry and you may have minor injuries, they are more likely to be your point of entry for infections. You must also keep in mind that we are made up of more germs than human cells. We are inhabited by billions of germs that live in symbiosis and in harmony with us.
"Washing your hands is not a luxury. The ten main routes of infection transmission are the ten fingers."
Are there any other hygiene measures that you recommend?
Washing your hands is the most important thing – with warm water and soap. Disinfectant is not necessary. The top ten routes of infection are the ten fingers. In addition, one must sneeze, not in the area, but sneeze into the arm. Because it's enough to think about how germs are transmitted. If this is due to droplet infections, they fly as far as I sneeze. Then they fall and lie on handles, etc. The viruses survive for a while. If the next takes it and touches the nose or mouth – you do it automatically, by the way – they are transferred. Other germs, such as measles or wet leaves, float very long in the air. That's why they are so infectious. If you are really sick, it is best to stay at home, not to get on a bus or to go to the office.
Where are the most germs in everyday life?
On the keyboard, on the phone, wherever you go. Door handles are of course also a risk. But it is no longer possible to attack a doorknob. Because most germs are benign. To live sterile, on the other hand, means that one does not form the immune system. If a malignant germ then appears, the immune system has not learned to fight it, the disease is more difficult.
Medicine has made tremendous progress with the discovery of antibiotics …
Ninety years ago you discovered penicillin. Previously, you had no treatment for bacterial infections. Before that, a staph infection could be a death sentence. With the discovery of antibiotics in the 50s, 60s and 70s, many were sought after and found. With that, modern medicine started because infections were no longer a problem. This allowed transplantation, surgery, prosthetics, neonatology and oncology.
But more and more germs are resistant to antibiotics. According to experts, this will be even the leading cause of death in 2050. Where do these germs come from?
Resistant germs have always existed. For example, in Peru, in a cave where humans had not been human for 100,000 years, researchers analyzed the soil and found that many germs were resistant to antibiotics. Because most antibiotics, such as penicillin, which is produced by fungi, are natural substances. To gain an environmental advantage, there are mechanisms of resistance in nature. These germs are no smarter in themselves and no longer contain toxins. They are so dangerous because there are very few or no treatment options.
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What are the most common infections with resistant germs?
Staphylococcus aureus, for example. It can normally settle in the nose or sit on the surface of the skin without doing anything. But he has things in his genome that can make him very angry. It can cause massive infections such as bone infections, abscesses, blood intoxication, skin infections and brain abscesses.
It also means that there is still a lot of resistant germs in Southeast Asia. If I go on vacation, what is the probability that I get infected?
35 to 40% of tourists come back with resistant germs. The infection occurs through eating or attacking surfaces. India, Romania, Italy and Greece also have a high risk of contracting a germ. The problem is that in many countries, antibiotics are freely available everywhere. It's really very bad. Any antibiotic you take can potentially lead to resistance. They do not have to hit you, but you can transmit these germs, and when the other falls sick, he has very bad cards in the therapy.
If I get a germ but I do not get sick: what is the probability that it will disappear by itself?
High. We see that the germ is usually invaded by other benign germs of the intestine within a few months. But it can take a few months.
Taking antibiotics without a prescription can result in resistance. When do antibiotics have no meaning?
For viruses, they make no sense and most infections are viral. For example, bronchitis is very often viral and it is the most commonly used disease for which antibiotics are useless. We have a large group of patients who take an antibiotic unnecessarily. Or even with the flu you do not need.
Also interesting: how much hygiene is still healthy?
If antibiotics do not work for the majority of diseases, why is their consumption so high?
On the one hand, we do not really have a good parameter to distinguish the virus from the bacteria. In addition, patients are often pressured to obtain antibiotics and doctors prescribe them. This is really an area where you have to start early education and tell the school that antibiotics are potent substances that also have side effects and that they lose their effectiveness if they are poorly administered. On the other hand, doctors need to be better educated in this regard. But resistance is not just a problem in the human domain.
Who else is responsible for this?
In veterinary medicine, about 40% of antibiotics are administered. They form resistances and these germs can then enter the body during the preparation of the meat. But agriculture also plays a role. Because animals excrete the resistant germs of course. Manure arrives in the fields and the germs are finally detectable, even in groundwater and rivers.
Is there hope for new drugs soon?
Rather no. Because there is a lot of investment in the development of new drugs, but not in new antibiotics.
Why do not companies want to invest in new antibiotics?
It's easy to explain. If someone in the field of oncology has a new way, he will pull it with all his might. This will have a lot of patients. New anti-infectives, on the other hand, enter the safe and are used only in certain patients. Of course, there is a fear that develops resistance to new antibiotics again. That is, for a company that wants to sell a lot, it's not good. After all, developing a new drug takes about ten years and costs a billion euros.
It seems logical. But how can this be changed?
Now, it is politics that demands that we need new substances and that this development takes place. After all, there are now germs that are no longer effective antibiotics. We try to mix the drugs and hope that it will help one way or another. This is going to be a huge problem. On the one hand, good hygiene and good nutrition prevent people from getting sick, but antibiotics have prolonged the life expectancy of 20 years. And if this pillar comes off with resistant germs that can no longer be treated, then life expectancy will drop considerably.
To the person:
Heinz Burgmann studied medicine in Vienna and deepened his knowledge during a stay abroad at the Faculty of Tropical Medicine of Mahidol University in Bangkok (Thailand). Since April 1, 2018, Burgmann has been professor of internal medicine specializing in the treatment of infections and tropical medicine at the Vienna MedUni and head of the clinical department of infections and tropical medicine in the Department of Internal Medicine I.
This article was originally published in News 30/2019.