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Antibiotic resistance is still a major health concern in Europe. The point of view of Pr Di Perri, expert in Infectious Diseases, in Torino, Italy.

Figure : Percentage (%) of invasive isolates of Staphylococcus aureus resistant to Methicillin (MRSA), in Europe, 2016

Question 1 : In your practice, do you think that antibiotic resistance is mainly a Health Authorities concern? Do you think public awareness is sufficient and do they feel concern?

Pr Di Perri : “The current situation concerning the presence and evolution of antibiotic resistance is mainly a formal concern for health authorities; with few exceptions, no action is taken as this would imply to involve too many top scientists, whose work would be out of the political and administrative control. The problem remains for the patients and their physicians. Public awareness fluctuates at low level, as the press tends to follow the political agenda. As for vaccines, there are more opinions against antibiotics and drugs in general than real fear of being sick with infections by drug-resistant bugs.”

Question 2 : In your practice, did you already experience antibiotic resistance issues with your patients in which pathologies, and in which proportion? Is there a patient profile subject to antibiotic resistance?

Pr Di Perri : “It happens every day when serving as consultant in several medical and surgical divisions. Gram-negative bacteria (e.g. KPC Klebsiella and Pseudomonas aeruginosa) are the most difficult to treat, although in some circumstances, we deal with colonization instead of true infection. Around 30% of Klebsiella sp. are carbapenemase producers (KPC) and 40% of P.aeruginosa isolates are resistant to 3rd gen. Cephalosporins as well as to carbapenems. Few newer drugs have some advantages but their duration over time will be predictably short as these antibiotics have the same mechanism of action of older and no longer active antimicrobials. The profile more prone to get infected with drug-resistant bugs is the one of patients at risk of multiple sequential episodes, whose clinical condition is characterized by several concurrent comorbidities (e.g. BPCO, diabetes, congestive heart failure, recipient of mechanical ventilation, etc). A frequent common denominator here is the advanced age.”

Question 3 : Do you think that bacterial lysates can help practitioners to manage antibiotic resistance problems?

Pr Di Perri : “Bacterial lysates have been repeatedly shown to have a measureable efficacy in reducing the n. and severity of clinical episodes classifiable as acute infections of the airways. Since the latter is one of the most frequent reasons for antibiotic prescription, it appears reasonable to envisage how a properly driven use of bacterial lysates may actually reduce the overall antibiotic prescription as well as the frequency of hospital admission.”