Ukumelana nama-antimicrobial (AMR) sekungenye yezinsongo ezinkulu empilweni yomphakathi yomhlaba wonke.

Ucwaningo olubalulekile olushicilelwe ku-I-Lancetkulinganiselwa ukuthiUkufa kwabantu abayizigidi ezingu-1.27 ngo-2019 kwakubangelwa ngqo ukumelana namagciwane abangelwa amagciwane (i-AMR), ngenkathi cisheUkufa kwabantu abayizigidi ezi-5 kuhlotshaniswa ne-AMR yamagciwaneNgokumangalisayo,Ama-73% okufa okubangelwa yi-AMR abangelwa amagciwane ayisithupha kuphela., kugcizelela isidingo esiphuthumayo sokuqapha okusebenzayo, ukuvimbela ukutheleleka, ukuphathwa kwamagciwane, kanye nokuxilongwa okusheshayo.

Phakathi kwalezi zifo ezibangelwa amagciwane, amabhaktheriya amathathu angewona ama-Gram afanelwe ukunakwa okukhethekile:

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

Lezi zidalwa ziya ngokuya zimelana nama-carbapenems—isisekelo sokwelashwa kwezifo eziningi ezimbi ze-Gram-negative—futhi ziqashelwa emhlabeni wonke njengezifo ezibangela izifo ezibaluleke kakhulu.

I-WHO Ikhomba Lawa Magciwane Njengabalulekilenoma Izinto Ezibaluleke Kakhulu

IUhlu Lwezifo Ezibalulekile Zebhaktheriya ze-WHO (BPPL) 2024ithola amabhaktheriya amelana namagciwane adinga ukutshalwa kwezimali okuphuthumayo ekuxilongeni okusha, ekwelapheni, emithini yokugoma, kanye namasu okuvimbela ukutheleleka.

Phakathi kweOkubalulekile/PhezuluOkubalulekileizifo ezibangelwa amagciwane yilezi:

• · Ayimelani ne-carbapenemI-Acinetobacter baumannii(UDOTI)
• · Ayimelani ne-carbapenemI-Pseudomonas aeruginosa(i-CRPA)
• · Ama-Enterobacteriale (CRE) angamelani ne-Carbapenem, okuhlanganisaI-Klebsiella pneumoniae(CRKP)

I-WHO igcizelela futhi ukuthi ukulwa nalezi zifo kudinga indlela ephelele yokuhlanganisaukuxilongwa okusheshayo, ukuqapha, ukuphathwa kwamagciwane (i-AMS), kanye nokuvimbela nokulawula ukutheleleka (i-IPC)kunokuthembela kuphela ekuthuthukisweni kwama-antibiotic amasha.

Iziqondiso Zomhlaba Wonke Ziqokomisa Ukubaluleka Kokuxilongwa Okusheshayo

Ukulwa ne-AMR kudinga okungaphezu nje kwama-antibiotic asebenzayo—kuncike ekuxilongweni okufika ngesikhathi nangokunembile.

IUhlelo Lokusebenza Lomhlaba Wonke lwe-WHO Lokumelana Namagciwaneikhomba ukuqinisa amandla elebhu kanye nokwandisa ukufinyelela ekuxilongweni kwekhwalithi njengezinto eziza kuqala ekuthuthukiseni ukuqapha kanye nokwenza ngcono ukusetshenziswa kwama-antimicrobial.

Ngokwakhela phezu kwaleli qhinga,Uhlelo Lokuxilonga Ukumelana Namagciwane lwe-WHO (2024)iqokomisa ukuxilongwa okusheshayo njengethuluzi elibalulekile:

• · Sekela ukuphathwa kwamagciwane (i-AMS)
• · Qondisa ukwelashwa okulwa namagciwane ngesikhathi esifanele futhi okufanele
• · Nika amandla ukuvimbela nokulawula ukutheleleka (i-IPC)
• · Qinisa ukuqapha kwe-AMR
• · Thuthukisa ukutholakala kokuqubuka kanye nokusabela ekuqubukeni
• 

Ngokufanayo,I-Infectious Diseases Society of America (IDSA)incoma ukuxilongwa okusheshayo kwama-molecule, lapho kutholakala khona, ukuze kutholakale izifo ezibangelwa amagciwane kanye nezindlela zokumelana kusenesikhathi, okuvumela odokotela ukuthi bathuthukise ukwelashwa okulwa namagciwane futhi banciphise ukuchayeka okungadingekile kuma-antibiotic e-broad spectrum.

II-European Society of Clinical Microbiology and Infectious Diseases (ESCMID)futhi incoma ukutholakala okusheshayo kwamagciwane akhiqiza i-carbapenamase ukuze kube lula ukuqaliswa kusenesikhathi kwezinyathelo zokulawula ukutheleleka kanye nokwelashwa okufanele ngamagciwane.

Ndawonye, ​​lezi zincomo zomhlaba wonke ziqinisa umyalezo ofanayo:Ukuxilongwa okusheshayo kwama-molecule sekuba yingxenye ebalulekile yokuphathwa kwe-AMR yanamuhla.

Ukuqonda i-KPN, i-Aba kanye ne-PA

I-Klebsiella pneumoniae (KPN)

I-K. pneumoniaekuyimbangela enkulu ye-pneumonia ehlobene nokunakekelwa kwempilo, ukutheleleka kwegazi, ukutheleleka komgudu womchamo, kanye ne-sepsis.

Imelana ne-carbapenemI-K. pneumoniaeivame ukuthwala izakhi zofuzo ze-carbapenemase ezifaka: i-KPC, i-NDM, i-OXA-48-like kanye ne-IMP.

Izinhlobo ze-hypervirulent zingase zihlanganise ukwanda kwe-virulence kanye nokumelana nemithi eminingi, okudale izinselele ezinkulu zokwelapha.

I-Acinetobacter baumannii (Aba)

A. baumanniiiyakwazi ukuqina kakhulu futhi iyakwazi ukusinda ezindaweni zemvelo isikhathi eside.

Kuhlobene kakhulu nalokhu:

• · Ukuqubuka kwezifo ze-ICU
• · I-pneumonia ehlobene nokuphefumula (VAP)
• · Ukutheleleka kwegazi
• · Ukutheleleka okuhlobene nedivayisi

Ikhono layo elimangalisayo lokuthola izinto ezibangela ukumelana ne-carbapenem lenze ukuthi imelane ne-carbapenemA. baumanniiesinye sezifo ezibangela izifo ezibhedlela okunzima kakhulu ukwelapha.

I-Pseudomonas aeruginosa (PA)

I-P. aeruginosaiyigciwane elisebenzisa amathuba elivame ukuthelela iziguli ezigula kakhulu kanye nezifo ezingasebenzi kahle.

Ukumelana kwangaphakathi, ukuzivumelanisa ngokushesha kwezakhi zofuzo, kanye nokwakheka kwe-biofilm kunegalelo ekuthelelekeni okuqhubekayo kanye nokwandisa ukumelana kwe-carbapenem emhlabeni jikelele.

Ukudluliselwa Kwezinsizakalo Zokunakekelwa Kwezempilo

Lezi zifo ezibangelwa amagciwane ezingamelani nemithi eminingi zidluliselwa kakhulu ngalezi zindlela ezilandelayo:

• · Imishini yezokwelapha engcolile kanye nezindawo zemvelo
• · Izandla zabasebenzi bezempilo
• · Iziguli ezikhuliswe emakoloni noma ezinegciwane
• · Ukukhishwa kokuphefumula
• · Amadivayisi ahlaselayo njengemishini yokuphefumula kanye nama-catheter

Ngokusho kwe-Izikhungo Zokulawula Nokuvimbela Izifo zase-US (CDC), ukutholwa kwasekuqaleni kwelabhorethri kuhlanganiswe nokuphathwa kwamagciwane kanye nezinyathelo eziqinile zokuvimbela ukutheleleka kubalulekile ekunciphiseni ukudluliselwa kwezinto eziphilayo ezingamelana nemithi eminingi okuhlobene nokunakekelwa kwempilo.

Izinselele Zokwelapha

Izindlela zokwelapha ziyaqhubeka nokuba zincane kakhulu.

Izinselele zamanje zifaka:

• · Ukwanda kokumelana ne-carbapenem
• · Ukutholakala okulinganiselwe kwemithi emisha yokulwa namagciwane
• · Ubuthi obuhambisana nama-polymyxin
• · Ukumelana okukhulayo nama-ejenti amasha

Ngenxa yalokho, iziqondiso zomhlaba wonke zincoma njalo ukuthola ubufakazi bezinto eziphilayo ngesikhathi esifanele ukuze kusekelwe ukwelashwa okuhlosiwe ngamagciwane noma nini lapho kungenzeka.

Kungani Ukutholwa Kwama-Molecular Okusheshayo Kubalulekile

Isiko elivamile kanye nokuhlolwa kokuzwela kwama-antimicrobial ngokuvamile kudingaAmahora angu-48–72ngaphambi kokuba kutholakale imiphumela engenzeka.

Ukuxilongwa okusheshayo kwama-molecule kunganciphisa kakhulu lesi sikhathi ngokuhlonza ngasikhathi sinye izifo ezibangelwa amagciwane kanye nezakhi zofuzo zokumelana ezibalulekile emtholampilo, okuvumela kusengaphambili:

• · Ukwelashwa okufanelekile kwe-antimicrobial
• · Ukungenelela kokuvimbela ukutheleleka
• · Izinqumo zokuphatha ama-antimicrobial
• · Ukuqapha izinto eziphilayo ezingamelani nezifo

Isixazululo se-Multiplex PCR sokwenza izinqumo ngokushesha emitholampilo

Ukusekela ukuhlonza ngokushesha amagciwane abalulekile e-Gram-negative kanye nezindlela zokumelana ne-carbapenem,Ikhithi Yokuthola I-Macro & Micro-Test's KPN, Aba, PA kanye ne-Drug Resistance Genes Multiplexithola ngasikhathi sinye:

Amagciwane aqondiwe: I-Klebsiella pneumoniae, I-Acinetobacter baumannii, I-Pseudomonas aeruginosa 

Izakhi zofuzo ze-Carbapenemase: I-KPC, I-NDM, I-OXA-48, I-IMP

Izici Eziyinhloko

• · Ukutholwa okuqondile okuvela ezibonelweni ze-sputum
• · Akudingeki ukucebisa amasiko isikhathi eside
• · Ukuzwela kokuhlaziya:I-LoD 1000 CFU/mL 
• · Imiphumela iyatholakala ku-Imizuzu engama-35–50 
• · Iyahambisana namapulatifomu e-PCR ajwayelekile ngesikhathi sangempela

Ngokuhlinzeka ngokuhlonza okusheshayo kwama-molecule ama-pathogen kanye nezimpawu zokumelana, ukuhlolwa kungahambisana nokusebenza kwe-microbiology evamile futhi kusekele ukwenziwa kwezinqumo zomtholampilo kusenesikhathi.

Ukusebenza Ndawonye Ngokulwa ne-AMR

Ukumelana namagciwane akukwazi ukunqotshwa ngama-antibiotic amasha kuphela.

II-WHO, I-IDSA, I-ESCMID, futhiI-CDCkugcizelelwa njalo ukuthi ukulawulwa kwe-AMR okuphumelelayo kudinga ukuhlanganiswa kwalokhu:

• · Ukuxilongwa okusheshayo
• · Ukuphathwa kwe-antimicrobial
• · Ukuvimbela nokulawula ukutheleleka
• · Ukuqapha kwelebhu
• · Ukungenelela kwezokwelapha ngesikhathi esifanele

Njengoba amalabhorethri emhlabeni wonke eqhubeka nokuqinisa impendulo yawo ye-AMR, ukuxilongwa okusheshayo kwama-molecule amaningi kungadlala indima ebaluleke kakhulu ekusekeleni izinqumo zokwelapha ezisekelwe ebufakazini nasekusizeni ukunciphisa ukusabalala kwamagciwane amelana namagciwane.

Izinkomba

1. Abasebenzisana Nabo Abalwa Namagciwane.Umthwalo womhlaba wonke wokumelana namagciwane amagciwane ngamagciwane ngo-2019. I-Lancet.2022.

2. Inhlangano Yezempilo Yomhlaba.Uhlelo Lomhlaba Wonke Lokusebenza Ngokumelene Namagciwane.2015.

3. Inhlangano Yezempilo Yomhlaba.Uhlu Lwezifo Ezibaluleke Kakhulu Zebhaktheriya ze-WHO 2024. 

4. Inhlangano Yezempilo Yomhlaba.Isinyathelo Sokuxilonga Ukumelana Namagciwane.2024.

5. I-Infectious Diseases Society of America (IDSA).Isiqondiso sika-2024 mayelana nokwelashwa kwezifo ezibangelwa yi-gram-negative ezimelana namagciwane. 

6. I-European Society of Clinical Microbiology and Infectious Diseases (ESCMID).Iziqondiso Zokuphathwa Kwezifo Ezibangelwa Yi-Gram-Negative Bacilli Engazweli Emithini Ehlukahlukene. 

7. Izikhungo Zokulawula Nokuvimbela Izifo zase-US (CDC).Izinsongo Zokumelana Nama-antibiotic e-United States.