Every year, more than 150,000 people suffer infections caused by antibiotic-resistant bacteria in Spain, with severe consequences for public health and a mortality rate exceeding 20,000 deaths annually. Antibiotic resistance is a phenomenon in which bacteria develop mechanisms to defend themselves against antibiotics and other antimicrobial drugs, making infections that were once easily treatable become dangerous and difficult to cure.

The inappropriate use of antibiotics in both humans and animals accelerates this resistance: the abuse of antibiotics or failure to complete treatments increases the likelihood that bacteria will develop resistance. Therefore, raising awareness and educating about the responsible use of antibiotics is essential to combat this global threat.

On European Antibiotic Awareness Day, held every November 18, we want to remind everyone of the importance of using these medications responsibly. The need for a shared commitment between patients, healthcare professionals, and researchers to prevent antibiotic resistance and address a public health crisis that requires urgent and coordinated action.

Research to understand resistance, conduct real-time epidemiological surveillance, and identify new therapies

From a research perspective, Vall d'Hebron Research Institute (VHIR) works to halt the advance of this global problem through projects characterised by a comprehensive approach. One of the most important projects is aimed at real-time epidemiological surveillance of multi-resistant bacteria, using state-of-the-art genomic techniques, to identify the entry and circulation of high-risk clones with great potential to cause infections that are difficult to treat, as well as to rationalise contact isolation measures, avoiding unnecessary harm to hospitalised patients. In addition, outbreaks of resistant bacteria are analysed to locate their origin, a key point in controlling their spread in hospitals and other settings.

This surveillance extends beyond the hospital, as resistance can also originate in environmental reservoirs, such as the mass use of antibiotics in agriculture and livestock, which contributes to the proliferation of resistant bacteria that can be transmitted to humans. For this reason, studying how environmental conditions and human health are interconnected is essential, following a "One Health" approach. This framework considers human, animal, and environmental health as interconnected and requiring coordinated actions.

Research also focuses on the characterization of resistance and virulence genes, i.e., studying the mechanisms that make bacteria more dangerous and resistant. Furthermore, efforts are being made to evaluate new antibiotics and therapeutic and diagnostic strategies for infections that are difficult to treat with current antibiotics.

These projects involve researchers from the Infectious Diseases, Microbiology, Epidemiology and Public Health, and Shock, Organ Dysfunction and Resuscitation (SODIR) groups at VHIR, in collaboration with the Microbiology, Infectious Diseases (both adult and pediatric), Intensive Care, and Preventive Medicine Services, among others.

New technologies to combat resistant infections

On the other hand, the Infectious Diseases group has developed several innovative technologies to combat antibiotic resistance, with the support of La Marató de TV3 and the "La Caixa" Foundation.

One of the most notable is the ThermoShot technology for treating infections in medical devices, such as catheters or prosthetics, which are often colonized by bacteria that form biofilms that are very difficult to eradicate. This technology uses silver nanoparticles combined with an antibiotic called amikacin, activated by heat, to eliminate multidrug-resistant bacteria more effectively. This would reduce treatment time and antibiotic use, and consequently, the emergence of resistance.

Other technologies, such as FlashShot and HeatShot, have also been developed to disinfect catheters and prevent infections in endotracheal tubes, respectively, offering innovative alternatives to reduce antibiotic use.

At the national level, the Microbiology and Infectious Diseases groups have been incorporated into the CIBER of Infectious Diseases (CIBERINFEC), which brings together over 500 scientists engaged in four programs. One of these programs is specifically geared towards addressing antimicrobial resistance, employing a translational approach to generate knowledge to regulate the emergence and spread of resistant strains, as well as enhance the prognosis of patients afflicted by these microorganisms.

Research focused on children

Specifically for pediatric patients, the Infection, and Immunity in Pediatric Patients group is researching the development and adaptation of different antimicrobial agents, previously approved for adult patients, to children and adolescents. The complexity of the patients treated at our center allows for the validation of the safety and efficacy of various next-generation antibiotics, antifungals, and antivirals in complex and often immunocompromised patients.

Similarly, active research is being conducted on the determination of plasma concentrations of various antimicrobials that enable the personalization of these therapies for pediatric patients, in collaboration with both national and international scientific societies. This includes special leadership in the proper use of systemic antifungal treatment.

A global commitment to responsible antibiotic use

From a healthcare perspective, ensuring the responsible use of antibiotics is crucial to curbing the growing threat of antimicrobial resistance, a problem that affects both patients and global public health. To combat this, a joint commitment from all parties (healthcare professionals, research institutions, and the public) is essential to ensure the responsible use of these medications. In this regard, Vall d'Hebron has implemented the Antimicrobial Stewardship Program (PROA), for both adults and children, to improve clinical outcomes, reduce adverse effects related to antimicrobial use (including the emergence of resistance), and maximize the cost-effectiveness of treatments.

One of the key strategies to combat antibiotic resistance is the AWARE program (Access, Watch, Reserve) from the World Health Organization, which classifies antibiotics based on the risk of generating resistance. This tool guides healthcare professionals in selecting the most appropriate antibiotics for each situation, ensuring that the most potent ones are reserved for severe infections that genuinely require them. Through AWARE, clinical and infectious disease units can offer safe and effective treatments while reducing the likelihood of generating resistance.

On the other hand, it is important to highlight that rapid and accurate diagnosis, through both clinical guidance and microbiological diagnosis, is key to selecting the appropriate treatment based on the type of bacteria. Only with quality samples it is possible to obtain reliable diagnoses that allow for fast, accurate treatments and that contribute to preserving the effectiveness of antibiotics.