“It’s something we haven’t really seen since the 1960s: people dying of pneumonia. But now it’s happening more and more, simply because antibiotics no longer kill the bacteria. Then it’s down to your own immune system, but that’s not always enough”, explains Chris Arts, a researcher at Maastricht University, speaking from his office in Randwyck. “Likewise, infections that occur during surgery can cause major complications. Think of a hip or knee replacement becoming infected. In the worst-case scenario, this can lead to amputation or even death.”
These kinds of cases are still relatively rare in the Netherlands, says Arts. Bacteria in the body can become resistant when patients use antibiotics too often, for too long or incorrectly. “Thankfully, we’re cautious about prescribing antibiotics in the Netherlands. But in many other countries, that’s not the case.” As a result, the number of resistant bacteria strains is increasing. “And bacteria don’t respect borders. They spread through physical contact, food and the environment. It’s a problem we can’t keep contained.”
This year alone, antibiotic resistance will cause around 4 million deaths worldwide, according to Arts. “If nothing changes, that number is projected to reach 20 million by 2050. That would mean tens of thousands of deaths in the Netherlands – a small city’s worth of people per year. And that’s not even counting the millions left chronically ill, which would drive healthcare costs through the roof.”
Reduce the reliance
In the search for solutions, researchers tend to focus on making existing antibiotics more effective or developing new classes. But that’s not a viable long-term strategy, says Arts. “It often takes longer to develop a new antibiotic than it takes for bacteria to develop resistance to it. That’s why we need to think bigger and find ways to reduce our reliance on antibiotics altogether.”
That’s exactly the aim of DARTBAC, an international consortium of over twenty universities and companies. In 2021, the project received nearly €10 million in funding from the Dutch Research Council (NWO) as part of the Dutch Research Agenda. And Maastricht University plays a key role in it: Arts leads the project, and “at least 25” UM researchers across various research groups are involved within DARTBAC. Just last week, dozens of researchers from all over Europe gathered at MECC Maastricht for the consortium’s annual conference.
A major focus of the research is infection prevention. This is one of the most effective ways to reduce the need for antibiotics, but it’s not as easy as it sounds, explains Arts. “Take prosthetic implants, for example. During surgery, bacteria from the patient’s skin can enter the body, attach to the implant surface and form an impenetrable layer of slime called a biofilm. As a result, the body’s own cells can no longer attach to the implant and there’s a risk of serious infections. So, we need to prevent biofilms from forming in the first place.”
Special goggles
This requires an understanding of how biofilms form and how bacteria communicate with each other, “so we can disrupt that process. Here in Maastricht, we’ve got the M4I Institute, which can visualize biofilm formation – very unique.” This insight is helpful in developing techniques and materials that make it harder for bacteria to attach to implants, or even kill them outright. “One promising approach is to heat implants just before insertion. This can be done in just about any hospital and doesn’t require expensive equipment. Textured implant surfaces also seem to make it harder for bacteria to attach. And we’re working on what’s known as ‘bioactive’ glass and gels that can change acidity levels to inhibit bacterial growth. These techniques are already fairly advanced. On top of that, we’re exploring things like special goggles that can light up bacteria during operations. This could be especially useful in soft-tissue procedures like intestinal surgery, where finding solutions is much harder than with hard surfaces like implants.”
Faster and better
DARTBAC aims to bring “at least three, but hopefully five” new technologies into clinical practice over the coming years, says Arts. A new lab in the recently renovated part of Universiteitssingel 50 will help make that happen. “It’s got state-of-the-art equipment – for everything from biomaterials research to animal studies – and more capacity, allowing us to work much faster and better.” With NWO’s funding, they’re set for the next three years. And when those millions run out? “We’d hoped to secure funding from the National Growth Fund [now scrapped by the government], so we’re currently looking into other options.”
In addition to new technologies, Arts believes something else is needed: greater awareness. “Clearly, the current campaigns aren’t doing enough. Some people still take antibiotics for colds – even though they don’t work on viruses – or stop taking them early, which increases the risk of resistance. Researchers at the UM Department of Health Promotion, amongst others, are studying how to improve education, not just for patients but also for nurses and doctors. I’m also pushing for antibiotic resistance to be more prominent in the medical curriculum.”