Kukana maantibayotiki (AMR) kwakhala chimodzi mwa zinthu zoopsa kwambiri pa thanzi la anthu padziko lonse lapansi.

Kafukufuku wodziwika bwino wofalitsidwa muLancetanaganiza kutiAnthu 1.27 miliyoni omwe anamwalira mu 2019 adachitika mwachindunji chifukwa cha kukana mabakiteriya oletsa maantibayotiki (AMR), pomwe pafupifupiImfa za anthu 5 miliyoni zinagwirizanitsidwa ndi AMR ya bakiteriyaChodabwitsa n'chakuti,73% ya imfa zomwe zimayambitsidwa ndi AMR zimayambitsidwa ndi tizilombo toyambitsa matenda 6 tokha, kugogomezera kufunika koyang'anira bwino matenda, kupewa matenda, kuyang'anira maantibayotiki, komanso kuzindikira matenda mwachangu.

Pakati pa tizilombo toyambitsa matenda, mabakiteriya atatu a Gram-negative ayenera kuganiziridwa kwambiri:

• · Klebsiella pneumoniae(KPN)
• · Acinetobacter baumannii(Aba)
• · Pseudomonas aeruginosa(PA)

Tizilombo toyambitsa matenda timeneti tikulephera kupirira ma carbapenems—chinthu chofunikira kwambiri pochiza matenda ambiri oopsa a Gram-negative—ndipo padziko lonse lapansi timadziwika kuti ndi tizilombo toyambitsa matenda tofunika kwambiri.

WHO Yazindikira Majeremusi Awa Ngati Ofunika Kwambirikapena Zinthu Zofunika Kwambiri

TheMndandanda wa Matenda Oyambitsa Matenda a Bakiteriya a WHO (BPPL) 2024imazindikira mabakiteriya osamva maantibayotiki omwe amafunika kuyika ndalama mwachangu pa njira zatsopano zodziwira matenda, mankhwala, katemera, ndi njira zopewera matenda.

Pakati paZovuta/ZapamwambaChofunika KwambiriMatenda opatsirana ndi awa:

• · Yosagwira CarbapenemAcinetobacter baumannii(NKHANU)
• · Yosagwira CarbapenemPseudomonas aeruginosa(CRPA)
• · Enterobacteriales (CRE) yosagonjetsedwa ndi carbapenem, kuphatikizapoKlebsiella pneumoniae(CRKP)

Bungwe la WHO likugogomezeranso kuti kuthana ndi matenda opatsiranawa kumafuna njira yokwanira yophatikizaKuzindikira mwachangu, kuyang'anira, kuyang'anira maantibayotiki (AMS), komanso kupewa ndi kulamulira matenda (IPC)m'malo mongodalira pa kupanga maantibayotiki atsopano.

Malangizo Padziko Lonse Akuwonetsa Kufunika kwa Kuzindikira Matenda Mwachangu

Kulimbana ndi AMR kumafuna zambiri kuposa maantibayotiki ogwira ntchito—zimadalira kuzindikira matenda nthawi yake komanso molondola.

TheNdondomeko Yadziko Lonse ya WHO Yokhudza Kukana Mankhwala Oletsa Kutupaimazindikira kulimbitsa mphamvu za labotale ndikukulitsa mwayi wopeza matenda abwino ngati zinthu zofunika kwambiri pakukweza kuyang'anira ndikuwongolera kugwiritsa ntchito maantibayotiki.

Pogwiritsa ntchito njira imeneyi,Pulogalamu ya WHO Yofufuza Kukana Mabakiteriya (2024)ikuwonetsa kuzindikira matenda mwachangu ngati chida chofunikira kwambiri:

• · Thandizani kusamalira maantibayotiki (AMS)
• · Kupereka malangizo a nthawi yake komanso oyenera okhudza maantibayotiki
• · Yambitsani kupewa ndi kulamulira matenda (IPC)
• · Limbitsani kuyang'anira kwa AMR
• · Kuthandiza kuzindikira ndi kuyankha mliriwu
• 

Mofananamo,Bungwe la Matenda Opatsirana ku America (IDSA)imalimbikitsa kuzindikira mwachangu mamolekyulu, ngati alipo, kuti azindikire tizilombo toyambitsa matenda ndi njira zodzitetezera msanga, zomwe zimathandiza madokotala kukonza bwino chithandizo cha maantibayotiki ndikuchepetsa kukhudzana kosafunikira ndi maantibayotiki amitundu yosiyanasiyana.

TheEuropean Society of Clinical Microbiology and Infectious Diseases (ESCMID)Amalimbikitsanso kuzindikira mwachangu mabakiteriya a Gram-negative omwe amapanga carbapenemase kuti athandize kukhazikitsa njira zothanirana ndi matenda mwachangu komanso kulandira chithandizo choyenera cha maantibayotiki.

Pamodzi, malangizo awa apadziko lonse lapansi akulimbitsa uthenga wofanana:Kuzindikira mwachangu mamolekyulu kukukhala gawo lofunikira kwambiri pa kasamalidwe ka AMR masiku ano.

Kumvetsetsa KPN, Aba ndi PA

Klebsiella pneumoniae (KPN)

K. pneumoniaendi chifukwa chachikulu cha chibayo chokhudzana ndi chisamaliro chaumoyo, matenda opatsirana m'magazi, matenda opatsirana m'mitsempha ya mkodzo, ndi sepsis.

Kusagwira CarbapenemK. pneumoniaeNthawi zambiri imakhala ndi majini a carbapenemase kuphatikizapo: KPC, NDM, OXA-48-like ndi IMP.

Mitundu ya mavairasi owopsa kwambiri ingaphatikizepo kuopsa kowonjezereka ndi kukana mankhwala ambiri, zomwe zimapangitsa kuti pakhale zovuta zazikulu pakuchiritsa.

Acinetobacter baumannii (Aba)

A. baumanniindi yolimba kwambiri ndipo imatha kukhalabe pamalo otetezedwa kwa nthawi yayitali.

Zimagwirizanitsidwa kwambiri ndi:

• · Kufalikira kwa matenda a ICU
• · Chibayo chokhudzana ndi mpweya wopumira (VAP)
• · Matenda a m'magazi
• · Matenda okhudzana ndi chipangizo

Kuthekera kwake kodabwitsa kopeza zinthu zomwe zimapangitsa kuti thupi likhale lolimba kwapangitsa kuti likhale lolimba chifukwa cha carbapenem.A. baumanniiimodzi mwa matenda opatsirana omwe ndi ovuta kwambiri kuchiza m'chipatala.

Pseudomonas aeruginosa (PA)

P. aeruginosandi tizilombo toyambitsa matenda tomwe timayambitsa matenda omwe nthawi zambiri amakhudza odwala omwe ali ndi vuto lalikulu la chitetezo chamthupi komanso omwe ali ndi chitetezo chamthupi chofooka.

Kukana kwa mkati, kusintha kwa majini mwachangu, komanso kupangika kwa biofilm kumathandizira kuti matenda apitirire komanso kuonjezera kukana kwa carbapenem padziko lonse lapansi.

Kutumiza kwa Anthu ku Zikhazikiko Zaumoyo

Matenda opatsirana omwe sagonjetsedwa ndi mankhwala ambiri amafalikira makamaka kudzera mu:

• · Zipangizo zachipatala ndi malo ozungulira omwe ali ndi kachilombo
• · Manja a ogwira ntchito zachipatala
• · Odwala omwe ali ndi matenda a m'matumbo kapena omwe ali ndi kachilombo
• · Matumbo otulutsa mpweya
• · Zipangizo zowononga monga ma ventilator ndi ma catheter

Malinga ndiMalo Oyang'anira ndi Kupewa Matenda ku US (CDC), kuzindikira koyambirira kwa labotale pamodzi ndi kuyang'anira maantibayotiki komanso njira zopewera matenda ndizofunikira kwambiri pochepetsa kufalikira kwa tizilombo toyambitsa matenda tosamva mankhwala ambiri chifukwa cha chisamaliro chaumoyo.

Mavuto a Chithandizo

Njira zochiritsira zikupitirirabe kuchepa.

Mavuto omwe alipo pano ndi awa:

• · Kuwonjezeka kwa kukana kwa carbapenem
• · Kupezeka kochepa kwa mankhwala atsopano opha tizilombo toyambitsa matenda
• · Kuopsa kokhudzana ndi polymyxins
• · Kukana kwatsopano kwa mankhwala atsopano

Chifukwa chake, malangizo apadziko lonse lapansi nthawi zonse amalimbikitsa kupeza umboni wa tizilombo toyambitsa matenda panthawi yake kuti tithandizire chithandizo cha maantibayotiki nthawi iliyonse yomwe zingatheke.

Chifukwa Chake Kuzindikira Mofulumira kwa Mamolekyu Kuli Kofunika

Chikhalidwe chachikhalidwe ndi mayeso oletsa kuukira kwa maantibayotiki nthawi zambiri amafunikaMaola 48–72zotsatira zake zisanapezeke.

Kuzindikira mwachangu mamolekyulu kumatha kufupikitsa nthawi imeneyi mwa kuzindikira tizilombo toyambitsa matenda ndi majini ofunikira kwambiri okana matenda, zomwe zimathandiza kuti pasadakhale:

• · Chithandizo choyenera cha maantibayotiki
• · Njira zopewera matenda
• · Zisankho zoyang'anira maantibayotiki
• · Kuyang'anira tizilombo tosagonja

Njira Yopangira Zisankho Zachipatala Mwachangu

Pofuna kuzindikira mwachangu matenda ofunikira a Gram-negative ndi njira zotsutsana ndi carbapenem,Macro & Micro-Test's KPN, Aba, PA & Drug Resistance Genes Multiplex Detection Kitnthawi imodzi imazindikira:

Matenda opatsirana omwe amabwera chifukwa cha matendawa: Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa 

Majini a Carbapenemase: KPC, NDM, OXA-48, IMP

Zinthu Zofunika Kwambiri

• · Kuzindikira mwachindunji kuchokera ku zitsanzo za sputum
• · Sikofunikira kukulitsa chikhalidwe kwa nthawi yayitali
• · Kuzindikira kwa kusanthula:LoD 1000 CFU/mL 
• · Zotsatira zikupezeka muMphindi 35–50 
• · Imagwirizana ndi nsanja zazikulu za PCR nthawi yeniyeni

Mwa kupereka chidziwitso chachangu cha mamolekyu a tizilombo toyambitsa matenda ndi zizindikiro zotsutsa, kuyesaku kungathandizire ntchito zachikhalidwe za microbiology ndikuthandizira kupanga zisankho zamankhwala koyambirira.

Kugwira Ntchito Pamodzi Polimbana ndi AMR

Kukana mankhwala opha tizilombo sikungatheke kudzera mu mankhwala atsopano okha.

TheWHO, IDSA, ESCMIDndiCDCakugogomezera nthawi zonse kuti kuwongolera bwino kwa AMR kumafuna kuphatikiza kwa:

• · Kuzindikira matenda mwachangu
• · Kusamalira maantibayotiki
• · Kupewa ndi kulamulira matenda
• · Kuyang'anira zasayansi
• · Kulandira chithandizo chamankhwala nthawi yake

Pamene ma laboratories padziko lonse lapansi akupitiliza kulimbitsa mayankho awo a AMR, kufufuza mwachangu kwa mamolekyulu a multiplex kungathandize kwambiri pothandizira zisankho zochiritsira pogwiritsa ntchito umboni komanso kuthandiza kuchepetsa kufalikira kwa matenda opatsirana omwe sagonjetsedwa.

Zolemba

1. Ogwira Ntchito Zolimbana ndi Mabakiteriya.Kulemera kwapadziko lonse kwa kukana mabakiteriya oletsa maantibayotiki mu 2019. Lancet.2022.

2. Bungwe la Zaumoyo Padziko Lonse.Ndondomeko Yadziko Lonse Yokhudza Kukana Mankhwala Oletsa Mabakiteriya.2015.

3. Bungwe la Zaumoyo Padziko Lonse.Mndandanda wa Matenda Ofunika Kwambiri a Bakiteriya a WHO 2024. 

4. Bungwe la Zaumoyo Padziko Lonse.Njira Yodziwira Kukana Mabakiteriya.2024.

5. Bungwe la Matenda Opatsirana ku America (IDSA).Malangizo a 2024 pa Chithandizo cha Matenda Osagwira Ntchito ndi Gram-Negative. 

6. European Society of Clinical Microbiology and Infectious Diseases (ESCMID).Malangizo Othandizira Kuthana ndi Matenda Oyambitsidwa ndi Bacilli Yosagwiritsa Ntchito Mankhwala Ambiri. 

7. Malo Oyang'anira ndi Kupewa Matenda ku US (CDC).Ziwopsezo Zotsutsana ndi Maantibayotiki ku United States.