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[00:05:41] Hello, this is.
[00:05:50] Tsarenko, chief resuscitator of the Ministry of Health
[00:05:53] of the Russian Federation. Sergey, what are antibiotics? Well, it's
[00:05:57] something against life, antibiosis? Well, that's terrible, we
[00:06:00] are also alive. I thought that antibiotics are medicine, no? Well,
[00:06:03] absolutely right, yes, but there are
[00:06:06] two types of animal world, prokaryotes
[00:06:10] and eukaryotes. We, thank God, are eukaryotes. That is, with
[00:06:13] a nucleus, and those without a nucleus, bacteria, the nucleus is what is inside
[00:06:17] us, it is our essence inside the cell, that which is inside
[00:06:20] the cell, when there is no nucleus, these are
[00:06:23] prokaryotes, bacteria, against them are antibiotics, although in general there are also antibiotics
[00:06:27] against tumors, but mostly they are against bacteria. Who produces them?
[00:06:30] Did chemists make them? Where do these substances come from in general?
[00:06:34] Well, for a start, they were actually found in
[00:06:37] nature, it's a way for
[00:06:40] bacteria to coexist
[00:06:43] with each other. Some bacteria produce antibiotics to expel other
[00:06:46] bacteria from their living
[00:06:48] niches, a struggle for
[00:06:52] food, for living space, and
[00:06:55] so on. And what does medicine have to do with it? We also have microbes on us, inside
[00:06:58] us, and antibiotics inside
[00:07:01] us too. Well, our bacteria also produce them, but actually
[00:07:05] our bacteria certainly don't produce the most powerful antibiotics
[00:07:09] that live in us.
[00:07:12] Uh... mostly these antibiotics are produced by bacteria
[00:07:15] living in the soil, so they are found
[00:07:18] there. After that, there are two options:
[00:07:22] modify them partially chemically,
[00:07:25] and the third way is to create an antibiotic
[00:07:28] entirely artificially, similar to the one found in
[00:07:32] nature. And these are some factories, microbiological industry or
[00:07:35] a chemical factory that makes this substance, it's some kind of molecule, right?
[00:07:39] It's a molecule. You are an intensivist. Do
[00:07:43] you encounter antibiotics in your medical practice?
[00:07:45] This is generally one of the main
[00:07:48] points of attention for me
[00:07:52] as an intensivist, because without
[00:07:54] antibiotics, modern
[00:07:58] intensive care will die. We use antibiotics in
[00:08:02] several situations. First, it's prophylactic antibiotic administration,
[00:08:05] for example, a patient is going for a planned surgical operation. This
[00:08:09] involves an incision of the skin before the surgical intervention.
[00:08:12] Therefore, perioperative antibiotic prophylaxis exists as
[00:08:16] a reasonable measure to reduce potential, but this
[00:08:20] is only in hospitals, that is, antibiotics, as I understand,
[00:08:23] are not taken preventively at home. No, this concerns
[00:08:27] a specific surgical intervention, and this
[00:08:30] antibiotic is administered about half an hour before the operation, with the expectation
[00:08:34] that it will only act during the surgical intervention. This
[00:08:38] is a single administration, it is a single or in extreme cases a double administration repeated during the operation.
[00:08:41] If the operation is long, and what if the antibiotic doesn't
[00:08:45] work? Then what? And if one
[00:08:47] antibiotic didn't work, then
[00:08:50] some inflammatory, purulent
[00:08:53] problems arose, then the antibiotic is changed. And if the second didn't
[00:08:57] work, it's changed to the
[00:08:59] third.
[00:09:02] Unfortunately, now we cannot
[00:09:05] choose for very long, because
[00:09:08] we live in an era of multi-resistant
[00:09:11] bacteria. This means that bacteria have multiple
[00:09:15] resistance to various groups of antibacterial drugs.
[00:09:18] Therefore, such a trial and error, as I said, is certainly not so blind, just one
[00:09:22] is prescribed, another is thrown out. It is selected based on the results of certain
[00:09:25] bacteriological studies, but nevertheless, the number of antibiotics that we can use in our
[00:09:29] clinical practice is now
[00:09:32] very limited. And why? I understood
[00:09:35] that, well, there are a lot of microbes around us, right? And
[00:09:39] you said that they communicate with each other through.
[00:10:12] chemically creates this antibiotic, it spends
[00:10:15] significant effort on the initial stage of finding
[00:10:19] or creating this molecule. The next stage is the company
[00:10:23] must test this antibiotic for effectiveness, for its
[00:10:27] possible side effects, for toxicity, and so on and so
[00:10:30] forth. This takes quite a lot of
[00:10:33] time and money, because modern options for
[00:10:36] bringing a drug to market carry a lot
[00:10:40] of restrictions. This is very reasonable, because it's a way
[00:10:43] to protect the patient from some
[00:10:46] undesirable side effects, everything must be studied quite
[00:10:49] thoroughly. The moment when the company finally passed this
[00:10:52] thorny path, spent...
[00:11:25] as a matter of fact, they have many
[00:11:27] mechanisms to hinder antibiotics. And what does this mean?
[00:11:31] You say that development is underway, scientists, companies
[00:11:34] made an antibiotic that kills bacteria. Well,
[00:11:37] Pseudomonas aeruginosa, you probably encounter it in your practice, right? So
[00:11:41] the name is beautiful, the antibiotic kills it. So everything is already
[00:11:44] like a magic bullet, everything is ready. Why does the problem
[00:11:48] arise in the first place? What is the problem? Look,
[00:11:51] bacteria, they multiply very quickly.
[00:11:56] In the process of reproduction,
[00:11:59] random mutations occur,
[00:12:02] which create a field for potential
[00:12:05] resistance of one or two or several bacterial
[00:12:08] cells to a new antibiotic. That is, they
[00:12:11] bypass, they bypass this option, for example,
[00:12:14] the antibiotic cannot penetrate the cell,
[00:12:17] there is a special penicillin-binding protein, for example, in the cell, it
[00:12:21] must pull this antibiotic into the cell,
[00:12:24] a defective one turned out to be a very valuable thing for bacteria from the point of view of evolution, because
[00:12:27] the antibiotic stops working. It's strange to me about economics, but if people can die if you've
[00:12:31] tried four antibiotics and nothing works, then it's
[00:12:35] the end, right? Probably.
[00:12:38] It's obvious,
[00:12:42] it's obvious that there's a very big interest among end
[00:12:45] consumers, families, yes, all of us, society, that antibiotics
[00:12:49] work. What does economics have to do with this at all? And you
[00:12:53] know, as a doctor, I treat economics
[00:12:55] as a somewhat lower-grade
[00:12:58] substance, forgive my bluntness, because
[00:13:02] the patient's needs are more important than money. But
[00:13:06] we have to reckon with the fact that these antibiotics must appear on
[00:13:09] the market. And so the company that brings
[00:13:12] it to market must spend this money, and
[00:13:15] accordingly, when the antibiotic stops
[00:13:19] functioning after 2-3 years,
[00:13:21] it turns out that the money was thrown away, well, not to the wind, but in any case.
[00:13:55] were precisely related to this, that there was not
[00:13:57] enough antibiotics that could be
[00:14:01] replaced. The quantity, in the sense that they ran out, they ran out of enough
[00:14:05] effective antibiotics. That is, look,
[00:14:08] before, well, I don't know, 5-7 years ago -
[00:14:12] new antibacterial
[00:14:15] so quickly that outdated,
[00:14:18] ineffective ones could simply be set aside. I, as an intensivist, always had, well, what we called
[00:14:22] a shoulder.
[00:14:55] there is always a chance, unfortunately, it's a biological
[00:14:58] law, that some bacterial cell
[00:15:02] will develop resistance, it wants to
[00:15:05] live, and will produce offspring that will be resistant to this antibiotic.
[00:15:09] The other question is that if the patient is not very
[00:15:12] sick, then they start to recover, they have enough strength
[00:15:15] to cope with the infection, well,
[00:15:18] relatively speaking, on their own, and there is no
[00:15:21] need to change the antibiotic. But in cases of severe patients, complex...
[00:15:25] Well, those same COVID patients, they
[00:15:27] were on artificial lung ventilation due to severe viral
[00:15:30] lung damage, they had an intubation tube, through which
[00:15:34] bacteria entered from the external environment. And we couldn't
[00:15:38] wean them off artificial lung ventilation because they didn't
[00:15:42] have enough of their own reserves. Therefore, in the process of treatment,
[00:15:46] he recovered, but at the same time, the lung damage was still
[00:15:49] high enough that I could wean him from
[00:15:53] artificial lung ventilation. Accordingly, he
[00:15:56] developed a new wave of bacterial infection, and these
[00:15:59] waves, in the end, overwhelmed him, and the person
[00:16:03] died.
[00:16:06] We're watching. Baden Baden Podcast, I'm your host, Konstantin
[00:16:10] Severinov. We are talking about antibiotics
[00:16:13] resistant to antibiotics, bacteria, with Sergey
[00:16:16] Vasilyevich Tsarenko, chief resuscitator of the Ministry of Health
[00:16:20] of the Russian Federation. What you are describing, it feels
[00:16:24] like game over will come soon, the game will end, right? If there are no new ones, then
[00:16:28] gradually all bacteria in the scenario you describe should
[00:16:31] become resistant, inasmuch as we use antibiotics, you
[00:16:35] use antibiotics, doctors, yes. And so
[00:16:39] antibiotic-resistant microbes emerge. Absolutely
[00:16:43] true. And then it should end soon,
[00:16:46] right? And that's a very sad thing. If you recall films
[00:16:50] from
[00:16:52] somewhere around the 1930s of the last century, when someone with
[00:16:56] lobar pneumonia lies there,
[00:16:58] breathing heavily, and the doctor treats him with some camphor so he doesn't
[00:17:02] die. The same story, we are actually heading towards it.
[00:17:06] haven't arrived yet.
[00:17:38] That is, they are simply forced, they are financed, they just don't
[00:17:41] want to. So these are such evil industrialists who, well, they
[00:17:44] could, but they simply leave the market
[00:17:48] from this. But this means that they have these antibiotics, they
[00:17:51] simply this means that they consider it economically unfeasible
[00:17:55] to develop them, develop them - it means to find new ones, to
[00:17:59] find new ones, yes, to which there is no resistance, to which
[00:18:02] there is no resistance yet. Well, this is such a vicious cycle, but
[00:18:05] you'll find what you described, that... you'll find it, but in 2-3 years
[00:18:09] you'll have to introduce a new one again, right? Absolutely right,
[00:18:13] in this vicious cycle you just need to live for some time, because
[00:18:16] you have to treat sick people with something, so new
[00:18:59] point of view, well, we can't move away.
[00:19:03] Microbes are everywhere, you said. Well, actually, the solution
[00:19:05] begs for...
[00:19:37] alive, but at the same time not
[00:19:41] to secrete virulence factors that kill
[00:19:44] the macroorganism, i.e., humans. That is, a theoretically achievable
[00:19:48] story, it's not science fiction,
[00:19:50] when the hypothetical Pseudomonas aeruginosa coexists
[00:19:54] with the patient, they exist perfectly, he
[00:19:58] lives with it, walks safely, she is with him,
[00:20:02] well, we have this skin bacteria on the surface, right? In the lungs, as far as I understand, it's
[00:20:06] usually there, so it basically coexists. So, somehow we need to understand why at some point it gets out of
[00:20:07] control,
[00:20:14] and we start to suppress it with antibiotics. At this moment, it, like
[00:20:18] that untamed planet, develops even more powerful means of
[00:20:21] attack, as a result everyone dies, both the patient
[00:20:24] and it. Well, that is, these are my personal relations with my
[00:20:28] personal microbes, when I am treated they become
[00:20:31] resistant, or I also transmit them to everyone else. And you transmit them to
[00:20:35] everyone else, because why? Firstly, well, you, I don't know,
[00:20:39] cough, you touch things with your hands, then
[00:20:42] someone else can pick it up. So antibiotic resistance is contagious,
[00:20:45] it turns out. Yes, bacteria, in fact,
[00:20:49] have learned to
[00:20:51] interact with each other in such a way that in some cases they simply
[00:20:55] transmit their ability to be resistant to antibiotics
[00:20:58] to each other. There is such a structure in
[00:21:01] a bacterial cell called a plasmid, well, like a small
[00:21:04] carriage, in this carriage live
[00:21:07] resistance genes, this carriage, New Year's
[00:21:10] gifts, yes, this New Year's gift, for example,
[00:21:14] from Pseudomonas aeruginosa can be transferred to Klebsiella or
[00:21:17] some other microbe, a completely different one.
[00:21:50] How do you know what to choose from the four antibiotics that you have in
[00:21:53] your arsenal? There are several points. The first
[00:21:57] point, of course, ideally, I must obtain the bacterium
[00:22:01] that is actually causing the infection
[00:22:04] from the specific patient. So I get
[00:22:08] the bacterium, I examine it in a certain
[00:22:11] way in the bacteriological laboratory,
[00:22:15] and test it for sensitivity to antibiotics. I have
[00:22:18] tested and understood that these...
[00:22:32] it gets worse, and there's a rule that the later you prescribe an
[00:22:34] effective antibiotic, the worse the results. Well, it's also obvious
[00:22:37] that if the bacteria wasn't caught the first time, but only the fourth time, that's
[00:22:41] much worse chances. Therefore, unfortunately,
[00:22:44] in this zone of uncertainty
[00:22:47] we have to work, and well, then it turns on... well, I would
[00:22:51] say, excuse me, common sense. Common sense says that
[00:22:54] a patient admitted, for example, from home with
[00:22:57] bacterial pneumonia, that most likely there's
[00:22:59] pneumococcus, with a high probability this pneumococcus
[00:23:03] is sensitive to certain antibiotics, and I
[00:23:06] prescribe these antibiotics, because I don't have
[00:23:09] time to wait. He didn't come to me in intensive care for nothing, he's already so bad that
[00:23:13] he needs to be treated in the intensive care
[00:23:16] unit, expecting that...
[00:23:50] again, this patient was admitted, right? Before
[00:23:53] prescribing antibiotics, I obtained some biological medium from him,
[00:23:57] either he coughed sputum into a Petri dish,
[00:24:01] or the patient was so severe that I had to insert an intubation tube, and I used a special
[00:24:04] bronchoscope to retrieve that sputum. Before
[00:24:08] I started treating with antibiotics, I would still
[00:24:11] take a culture of the medium. But you
[00:24:15] talk about common sense, you talk about common sense. I
[00:24:18] had COVID twice, but not severely, thank God. But a doctor came to
[00:24:22] my home, prescribed antibiotics, he didn't take anything from me. The doctor
[00:24:25] who prescribed you antibiotics for COVID wasn't treating you or even
[00:24:29] COVID. I call it treating, the doctor was treating
[00:24:32] fear in the pit of his stomach, his own fear.
[00:24:36] No, he was very scared for you. Well, but I'm not
[00:24:40] making it up, doctors did prescribe antibiotics, didn't they? Yes, it was
[00:24:43] the idea, which at first also seemed to them
[00:24:47] to be common sense. Common sense
[00:24:50] suggested that a viral infection
[00:24:53] cannot help but weaken the human body, and if it
[00:24:57] weakens the human body, then bacteria living
[00:25:00] in us or present in
[00:25:03] the environment will attack these affected lungs. In this
[00:25:07] context, there will be terrible bacterial pneumonia, from which
[00:25:10] the patient will die. Therefore, to prevent this from
[00:25:13] happening, he needs to be given an antibiotic. For example,
[00:25:16] the widespread use of azithromycin
[00:25:20] during the pandemic led to a shortage of it in pharmacies
[00:25:24] at one point, it was hard to find, even in pharmacies. Well, fortunately,
[00:25:28] in our country it was in shorter supply than, for example, in some China. This is
[00:25:31] good, this turned out to be good, thank God, because now this
[00:25:35] mycoplasma pneumonia, which, for example, many are now writing about in China,
[00:25:38] is also a bacterium, only it is a rather peculiar one, it's mycoplasma. In
[00:25:42] China it is multiply resistant to azithromycin. Here, fortunately,
[00:25:45] azithromycin doesn't work on this
[00:25:49] mycoplasma yet. Therefore, we didn't very much shower
[00:25:51] patients with a mountain of azithromycin, and it
[00:25:55] is still in the arsenal, at least.
[00:25:57] And what then should a consumer do? I am a consumer in
[00:26:01] this case, that is... a doctor comes, a person with a diploma,
[00:26:04] prescribes antibiotics to me. I mean, do I need to
[00:26:07] ask him why? Do I need to argue? Do I need to, after all, he
[00:26:11] might send me to the grave this way?
[00:26:15] No, well, he won't send you to the grave, well, if something else happens
[00:26:18] later, this is a strategically incorrect decision. Tactically,
[00:26:22] it won't kill you, it won't send you to the grave, but strategically,
[00:26:26] the decision is wrong. Strategically it's wrong to take
[00:26:28] antibiotics, to take antibiotics for a viral infection, yes...
[00:27:02] to sell, because I'm an intensivist, I don't work in a
[00:27:05] polyclinic, I don't have prescription forms, I know
[00:27:09] when I personally need an antibiotic, and when I don't.
[00:27:12] But I'm glad that we still, and even I couldn't buy it without
[00:27:16] a prescription at the pharmacy. So you are in favor of more regulation
[00:27:20] of this whole area, more bureaucracy? Absolutely it needs to be
[00:27:24] regulated, to be strictly regulated. And what
[00:27:28] about, you know, there's labeling on
[00:27:31] food, on meat, yes, that it's grown without antibiotics. I understand that
[00:27:35] much of the agricultural produce we consume
[00:27:38] is grown with, I don't know, maybe cows get sick or for some other reason, there are antibiotics there
[00:27:42] too. This is a very sad story, actually,
[00:27:45] the over-the-counter sale of antibiotics in pharmacies is such a
[00:27:49] tiny contribution that it makes to bacterial
[00:27:52] resistance, to antibiotics. The main thing, of course, is agriculture.
[00:27:56] They get sick because
[00:27:59] of viruses, chickens get sick, or whoever gets sick. It's not even about diseases,
[00:28:03] actually, antibiotics, it's our American partners who once found
[00:28:07] this beautiful idea: if you inject
[00:28:10] a cow with an antibiotic, it gains weight faster. That is,
[00:28:14] meat, again, economics, meat will be cheaper then, probably meat
[00:28:17] becomes cheaper, there's more of it because you inject antibiotics,
[00:28:21] and they also get prescriptions, where do they get
[00:28:24] these antibiotics? The whole sadness is that antibiotics used in the agricultural
[00:28:28] industry are
[00:28:30] those needed in...
[00:28:33] in medicine. For example, there is an antibiotic called colistin. For now, it is the
[00:28:36] main reserve against the infamous Pseudomonas aeruginosa,
[00:28:40] E. coli. When you tried number one, number two and number three, you switch to
[00:28:43] colistin, absolutely true. So,
[00:28:47] chickens in China, for example, are treated with colistin. Agriculture
[00:28:50] solves the problem of feeding the people and
[00:28:52] at the same time, gifting the people resistance
[00:28:56] to colistin. Therefore, when people get severe bacterial
[00:29:00] infections, colistin will not help them. The more you use
[00:29:03] an antibiotic, the more resistance there is to it. And an antibiotic
[00:29:06] is like an atomic bomb for bacteria, it kills everyone,
[00:29:09] or is it not an atomic bomb?
[00:29:12] But we also have beneficial microbes, right? So
[00:29:16] it's not just about beneficial microbes. So, look, the thing
[00:29:20] is that we hardly ever use such
[00:29:24] high-precision weapons against antibiotics now. These are the so-called
[00:29:27] against microbes, against microbes, yes, I misspoke. These are the so-called
[00:29:31] bacteriophages, that's a separate topic. song, what is it, they
[00:29:34] sell them in pharmacies, I know, those they sell are not very effective, for
[00:29:38] this there are certain reasons, so we have to
[00:29:41] select combinations of antibiotics for now, considering that
[00:29:45] they might enhance each other's effect, and
[00:29:48] then, we returned to where we, from where we started,
[00:29:51] that new antibiotics are needed and while they are
[00:29:55] being invented, the development of strategies is needed when we will
[00:29:59] not kill bacteria that live
[00:30:06] in us, that is, we will somehow learn to interact, there will only be antibiotics that kill bad microbes, but not affect good ones,
[00:30:10] there will be antibiotics that limit the pathogenicity of bacteria, that is, their
[00:30:14] disease-causing ability, that is, ideally it should remain with us for life
[00:30:18] a purulent bacillus, but simply not kill us, in
[00:30:21] general, this is not science fiction, you see, a doctor,
[00:30:25] he is not a scientist, a doctor, he is a consumer, I can only
[00:30:28] say that I would need this, but I don't know how
[00:30:32] to do it, I lack biological knowledge, I lack chemical knowledge, and you communicate with
[00:30:35] scientists, with Russian scientists, that is, I understand that
[00:30:38] there is a demand, you need this very much, and most importantly, patients need it, yes,
[00:30:42] you see, we communicate, now there are several developments, for example, in the same
[00:30:45] Gamaleya Institute, there
[00:30:48] are attempts to bring to the market an antibiotic called
[00:30:51] ftorquinolones, it has certain prospects, but it
[00:30:55] is also not a magic bullet, strictly
[00:30:57] speaking, that will solve everything, so here a
[00:31:01] certain spectrum is still needed. the development of new antibiotics should be
[00:31:04] simply supported only by state grants,
[00:31:07] money and, well, what
[00:31:11] is called,
[00:32:37] Where do antibiotic-resistant microbes come from, why
[00:32:40] antibiotics don't work, we'll talk about this and much more
[00:32:44] today in...
[00:32:53] in how many cases antibiotics work, what percentage
[00:32:57] of bacteria are resistant? 5% or if 90%, then
[00:33:00] this is probably a really hopeless clinical situation, I would say
[00:33:04] so, I would estimate them at around
[00:33:07] 10%, these are people whom you cannot help, they
[00:33:11] will be as if there are no antibiotics, then, well, it's a toss-up.
[00:33:15] Absolutely right, yes, so, I will try to find
[00:33:18] a combination of antibiotics for this patient, based simply on
[00:33:22] common sense, and some will be lucky, and some won't, you are
[00:33:25] now saying 5-10 years today, and 5
[00:33:29] years ago, for example, how many according to your practice, 5 years ago it
[00:33:31] was 2-3%.
[00:33:35] Well, in our case with pneumonia on mechanical ventilation, the mortality was
[00:33:38] 30-40% before the pandemic, the mortality was due
[00:33:42] to the fact that you could not, you could not pick it up.
[00:33:46] And one of the reasons was, one of the reasons was, well, there was also the severe
[00:33:50] severity of the pneumonia itself and so on, but in general
[00:33:54] 30-40%, and at that time the math
[00:33:57] and common sense don't add up, you say
[00:34:01] that patients who cannot be helped now are 5
[00:34:03] -10% due to antibiotic resistance,
[00:34:07] on the other hand, you say that the mortality rate of pneumonia is 30-40, this is
[00:34:10] a big gap, and this mortality is due to the fact that antibiotics don't work, did I
[00:34:14] understand correctly? Look, here we are talking about different
[00:34:18] nosological groups, different groups of patients, for example,
[00:34:21] patients with viral pneumonia, these were extremely
[00:34:25] severe patients, lying for a long time, this is
[00:34:28] one, there are simply not so many such patients, now in general
[00:34:31] the proportion of such patients has decreased,
[00:34:35] thank God, so I say that an approximate assessment of
[00:34:38] such a patient, whom every
[00:34:41] tenth cannot help, but this can all return back, bacteria can become resistant again.
[00:35:15] efforts and now we have what we have, right, but initially
[00:35:19] this was not the case, so, probably, they should have been able to return to normal, well, I
[00:35:22] see only one option, we stop using antibiotics completely, we just
[00:35:26] make a moratorium, for how long should it be done so that everything returns to
[00:35:29] normal, ah, well, let's just understand that during the moratorium patients will
[00:35:33] die, will such an option suit us, well, if antibiotics don't work, they will still
[00:35:37] die, ah, well, good, here is your specific
[00:35:40] relative lying in my intensive care unit, I tell you,
[00:35:43] Konstantin, you know, there is resistant flora here.
[00:35:45] I will come to you with a knife to your throat begging, well, find
[00:35:48] something,
[00:35:52] ideally, since we are friends, we will find a combination, maybe, or maybe
[00:35:55] not, yes, on the other hand, I have an analysis
[00:35:59] of sensitivity, all the letters of antibiotics are r, that is, resistant, from
[00:36:03] a formal point of view, there is nothing to prescribe, so if
[00:36:06] we theoretically did not prescribe
[00:36:08] to these patients, they would have died along with their
[00:36:12] bacteria, then... I think it's a matter of a few
[00:36:16] years, well, this is such an extrapolation of data, there is such
[00:36:19] a method of withdrawing an antibiotic from practice
[00:36:22] in your hospital and seeing when it will work
[00:36:26] again. usually
[00:36:36] this process takes about a year,
[00:36:40] I heard that in 4-5 years the frequency
[00:36:44] of resistant microbes has doubled, maybe
[00:36:47] multidrug resistant, so then in 5 years it
[00:36:51] will become even more and in general, however,
[00:36:54] I don't quite understand what a state program in itself will do. Well, how, can't
[00:36:58] a new group of antibiotics be found that will
[00:37:12] COVID we talked a lot about it, including me,
[00:37:16] now this topic has somehow faded
[00:37:20] into the background, there are other concerns, but nevertheless,
[00:37:23] unfortunately, the fact remains a fact, and my colleagues in
[00:37:27] this regard are not perfect, I must
[00:37:30] clearly say that, antibiotics are prescribed just in case, this
[00:37:33] applies to colleagues of any nationality, American, Chinese,
[00:37:37] Russian, this is generally - just in case, what about us?
[00:37:41] Well, in China they use colistin in agriculture,
[00:37:44] for example, and you ate Chinese chicken and your microbes
[00:37:47] received microdoses of colistin, well, and at the same time
[00:37:51] I understand that a microbe that has become resistant to
[00:37:54] colistin, even if it didn't come here from chicken. Since
[00:37:58] there are no borders for microbes, yes, it still spreads eventually across the entire
[00:38:02] planet, that is, what happens in America or Chile is important for us, because
[00:38:06] these microbes will end up with us, on the contrary, absolutely right, sooner or later
[00:38:09] it will happen, this is practically an apocalypse, this is
[00:38:13] practically, you talk about it so calmly, but I've already overcome
[00:38:16] this topic, I don't know, you've become resistant, well,
[00:38:20] you can't always live in a state of
[00:39:33] antibacterial soap, it will clean all your skin
[00:39:37] from bacteria, including beneficial ones, and there are antibiotics, because
[00:39:40] there is, because there is an antiseptic, well, this is like an antibiotic,
[00:39:44] such a drug that kills bacteria
[00:39:47] on the surface, washed with antiseptic,
[00:39:50] treated hands, no bacteria, in fact, this is completely unnecessary, because when
[00:39:54] you just washed with regular soap, the number of bacteria...
[00:39:58] decreased to 30-40% of the
[00:40:00] initial hundred that were on your dirty hands, this is enough not
[00:40:04] to get some intestinal infection, for example, and
[00:40:07] if you treated 100%, killed with antibacterial
[00:40:11] soap, then sooner or later pathogenic
[00:40:14] bacteria, disease-causing, will settle on your skin, so you don't need
[00:40:18] to remove too much, you need to wash your hands before
[00:40:22] eating and after the street, but not with antibacterial
[00:40:26] soap, I ask...
[00:40:58] with bacteria. Thank you very much.