Antibiotic resistance is advancing silently and could become one of the deadliest health threats of the coming decades, according to Domingo Gargallo, a microbiologist and director of Funditec Health. Speaking on the occasion of World Patient Safety Day, which this year focuses on antimicrobial resistance, Gargallo warned that the figures are alarming: nearly 3 million deaths recorded in 2019 could rise to 10 million per year by 2050 if new antibiotics are not developed.
Gargallo, who has studied the phenomenon for years, argues that the problem extends far beyond how antibiotics are prescribed in clinics. The drugs are also used massively in food production — on farms, in fish farms and in increasingly common hydroponic crops — multiplying the environments where bacteria can develop resistance. He also highlights a factor that often goes unnoticed: waste disposal systems in hospitals and nursing homes concentrate large amounts of pathogens alongside very high doses of antibiotics, turning these settings into perfect breeding grounds for multidrug-resistant strains.
The microbiologist describes antibiotic resistance as a «silent pandemic» precisely because its victims rarely make headlines. Those most affected are immunosuppressed patients, transplant recipients and people undergoing cancer treatment, whose deaths are often attributed to other conditions when in fact they would not have occurred without the infection. Because this happens in hospital settings rather than in public view, the problem remains off the media radar and its true severity goes unnoticed by society.
Although the issue has gained prominence in recent years, Gargallo notes that it is not new: it has been on the agenda of the United Nations, the European Union, the G20 and the G7 for decades. What has changed is public awareness, driven by educational efforts such as the National Plan against Antibiotic Resistance. He recalls a European study showing a clear correlation between the level of public knowledge about antibiotics and the percentage of resistance in each country: in Nordic countries, where there is greater understanding of their proper use, resistance is lower, while in countries with less education on the matter, rates are among the highest.
For Gargallo, that knowledge is the key to patient safety. «Using it when needed and using it correctly is the first step to good safety, without a doubt,» he summarises. From his clinical experience, he acknowledges that one of the main obstacles remains the lack of rapid, affordable tools for precise prescribing, especially in primary care, where treatment is still largely empirical. On a positive note, he points out that more and more doctors are distinguishing better between viral and bacterial infections before prescribing.
When an antibiotic stops working, the consequences can be severe: in severe infections, every hour without adequate treatment can increase the risk of death by up to 10%, making the right choice at the right time crucial. The patients most at risk are again the immunosuppressed — transplant recipients, those undergoing cancer treatment or those who have had very complex surgeries — in whom the health system has often invested enormous technological and human effort. «Those patients should not have to lose their lives if it were not as a consequence of being exposed to these bacteria that they cannot fight and that we have no effective antibiotics to eliminate,» Gargallo laments.
In the most extreme cases, superbugs appear — microorganisms practically resistant to all available classes of antibiotics, against which few options remain: sometimes only surgery, or combinations of antibiotics at very high doses as a last resort. The COVID-19 pandemic also left an unresolved lesson about antibiotic use. Antibiotics were frequently administered despite the infection being viral, not to fight the virus but preventively, given the deterioration many patients suffered. Gargallo understands that decision as typical of an emergency context, but recognises its cost: intensive antibiotic use is directly linked to the emergence of resistance, and the result was a notable increase in the percentage of resistant strains after the pandemic.