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有超级抗生素可以战胜超级细菌“飽曼不动杆菌”?

2017-08-25 19:40:59   中国经济网

2017年世界卫生组织(WHO)公布的十二大耐药性细菌排名显示,鲍曼不动杆菌赫然排名在级别1-严重耐药性的第一名!

由此,国内医学专家呼吁,加强抗生素药品管理,以应对21世纪的“超级细菌”威胁。

鲍曼不动杆菌可能进化成 “超级细菌”

一般人们把对几乎所有抗生素有抗药性的细菌统称为超级细菌。它能在人身上造成脓疮和毒疱,甚至逐渐让人的肌肉坏死。这种病菌的可怕之处并不在于它对人的杀伤力,而是它对普通杀菌药物——抗生素的抵抗能力。对这种病菌,人们几乎无药可用。

在我国,鲍曼不动杆菌(Ab)目前已经是国内医院感染的重要病原菌。近年来的感染逐渐增多,且其耐药性日益严重,已引起临床和微生物学者的严重关注。

Ab主要引起呼吸道感染,也可引发败血症、泌尿系感染、继发性脑膜炎等。 Ab在医院的环境中分布很广且可长期存活,对危重患者和CCU(冠心病重症监护室)及ICU(综合性重症加强护理病房)中的患者威胁很大,也将此类感染称做ICU获得性感染。

2016 年CHINET监测数据显示,鲍曼不动杆菌占所有呼吸道标本分离菌的17.7%,位居第一位。血液标本分离菌的7.3%,其他无菌体液分离菌的6.8%,伤口脓液分离菌的3.7%,尿液标本分离菌的1.7%。

更为严重的是,鲍曼不动杆菌在我国的耐药情况正日趋严重。

2016年中国CHINET监测数据显示:不动杆菌属对头孢哌酮/舒巴坦耐药率为43%、米诺环素为44.9%,对哌拉西林/他唑巴坦耐药率在66.9%,帕尼培南为65%,美罗培南为71%,亚胺培南为67.4%,其他药物如头孢吡肟、头孢他啶、左氧氟沙星、莫西沙星、环丙沙星、氨苄西林/舒巴坦、庆大霉素、哌拉西林等,耐药率均在60%以上。

第三代头孢复方抗生素成最后一道常规防线

据美国流行病学控制中心统计,美国每年约有200万人受到耐药细菌的感染,其中有2.3万名患者最终死亡。据估计,美国每年健康系统为耐药细菌感染患者的支出高达210亿~340亿美元。而英国前首相卡梅伦的报告估算,到2050年每年将有1000万名患者因为耐药细菌感染死亡,每年全球为耐药细菌治疗的支出将高达100万亿美元。

由于第三代头孢抗生素加入舒巴坦后,可以减少细菌耐药性的产生,因此其复方针剂在鲍曼不动杆菌感染治疗中被大量应用。其中,头孢噻肟/舒巴坦、头孢曲松/舒巴坦可以透过血脑屏障,特别对由鲍曼不动杆菌引起的院内感染和颅内感染,无需鞘内注射,直击颅脑内的鲍曼不动杆菌。

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