Antibiotic resistance on the world map
Russian scientists have created a world map of antibiotic resistance
Russian scientists have created an interactive world map of the resistance of the intestinal microbiota to antibiotics. ResistoMap will help identify national characteristics in the consumption of antibiotics and monitor drug resistance on a global scale. The technology is presented in the journal Bioinformatics (Yarygin et al., ResistoMap–online visualization of human gut microbiota antibiotic resistome), and the resource itself is available at the link.
In 2014, the World Health Organization (WHO) in its report for the first time identified the problem of antibiotic resistance as a serious danger to human health. "Due to the lack of prompt and concerted action, our world is entering an era when antibiotics are losing effectiveness, and common infections and minor injuries that could have been cured for many decades are now starting to kill again," said WHO Assistant Director–General for Health Safety Keiji Fukuda. Microbial drug resistance is caused by the widespread uncontrolled use of antibiotics in medicine and agriculture: it is predicted that by 2050, about 10 million people will die annually due to drug resistance-related causes. Russian scientists from the Federal Scientific and Clinical Center of Physico-Chemical Medicine, the Moscow Institute of Physics and Technology and the Data Laboratory have created ResistoMap, a web-based interactive visualization of intestinal resistoma (from Latin. resisto – I resist) – the presence of drug resistance genes to the action of antibiotics in the human gut microbiota. The navigation layer of the geographical map allows us to formulate hypotheses about global trends in antibiotic resistance and compare the features of intestinal resistoma with national drug use practices.
Why microbiota?
The microbiota (microbiome, microflora) of a person is the totality of all microorganisms in the human body. Of all the organs, tissues and environments of the body, the intestinal microflora is the dominant in number. Scientific research in recent years has shown that, in terms of its importance for human life, the gut microbiota is another organ consisting of a huge number of bacteria, both attached to the intestinal wall and living in its lumen. Remaining invisible, this "organ" weighs about two kilograms and has about 10-13 (ten trillion) cells of microorganisms. According to molecular genetic studies, the species composition of the microflora is stable over time, but it can change greatly with a sharp change in diet or taking antibiotics. The intestinal community is a complex ecosystem of hundreds of species, in whose genomes 2 orders of magnitude more genetic information is encoded than in the human genome. The totality of these genomes – the metagenome – contains, among other things, a "behavioral code" for community members that determines their food and other connections between themselves and the outside world. Proper metabolism, healthy blood vessels, normal digestion, resistance to external infections (the state of immunity) of a person is largely determined by the stability, one might say, the "health" of his microflora.
The pool of antibiotic resistance genes (which give bacteria resistance to the action of the drug), the level of which increases during antibiotic treatment, is potentially a "yoke" in the transfer of these genes to the pathogen and has serious consequences both for the individual and for society as a whole. The analysis of the functional composition of the microbiota using metagenomics makes it possible to estimate the prevalence of resistance genes in the human microbiota and, thus, in the future, to provide an individual prognosis for the ability of the human microbiota to contribute to the resistance of pathogens. To date, extensive volumes of metagenomic data on the intestinal microbiota have been published, which make it possible to assess the spread of the structure of the resistome in healthy populations around the world, as well as in patients with various diseases.
ResistoMap contains two main interactive working fields – geographical and heat maps. The user can select the group of antibiotics of interest or the country that will be displayed in the heat map and get a slice of the resistome. The data can be filtered by country, gender, age and diagnosis. At the moment, the developers have analyzed data for more than 1,600 people from 12 studies covering 15 countries for the level of the resistome, while it is possible for users of the resource to add new published data to the resistome map in a single format.
Features of different countries
Using ResistoMap, it is possible to assess the global change in the potential of resistance to various groups of antibiotics and to study the links between specific drugs and clinical factors. For example, Danish metagenomes, as a rule, show the lowest level of resistome among European groups, while French samples have the highest levels, especially fluoroquinolones, broad-spectrum antibacterial drugs. This is consistent with the fact that France has the highest overall level of antibiotic use in Western Europe, and Denmark and Germany are countries where antimicrobial use is moderate in both healthcare and agriculture. On the other hand, the Chinese and Russian populations have a higher level of resistance – probably due to less stringent rules for the use of antibiotics, frequent prescribing of broad-spectrum antibiotics, as well as the easy availability of antibiotics without a prescription. The lowest levels of microbiota resistance are observed in an isolated population of Indians from Venezuela, who have virtually no contact with the population of developed countries. The analysis reveals some new trends that await further interpretation from a clinical point of view.
Konstantin Yarygin, one of the authors of the development: "We assume that the exploratory analysis of the global landscape of antimicrobial resistance of the intestinal microbiota using ResistoMap will prompt researchers with new ideas on how to optimize the use of antibiotics in medicine, as well as in agriculture."
What should readers do?
What rules should be followed when treating with antibiotics so as not to lose our battle with bacteria? The most important rule is to use antibiotics strictly according to the doctor's prescription, to carry out treatment until the end (even if the symptoms subsided earlier) and not to reduce the dosages prescribed by the doctor. According to Russian research, every fourth mother does not complete the course of antibiotics prescribed to her child. At the same time, it is impossible to delay the reception for a longer period – this gives the infection an additional chance to find a way to combat the drug. Only the "golden mean" is able to effectively stop the infection. Narrow-spectrum antibiotics, that is, acting on a limited number of bacteria, are safer and preferable to broad-spectrum drugs. If it is possible to accurately identify the causative agent of infection, the more accurate the exposure, the less chance of survival of pathogenic bacteria.
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06.04.2017