Le superbug engamelana ne-colistin itholakala e-United States
Ngesikhathi sokuphatha kwakhe, uMengameli Obama uthola iphutha elikhulu ekukhipheni ama-executive orders. I-oda elilawulayo livumela umongameli ukuthi abeke inqubomgomo ngaphandle kwe-Congress futhi azuze inkhulumomphendvulwano yomphakathi.
Nakuba ezinye ze-oda eziphezulu zika-Obama ziye zaholela ekuphikisaneni okuphikisanayo nokuphikisana, inzuzo yabanye iyakwaziswa kabanzi. Ngokukodwa ngo-2015, u-Obama wakhipha uhlelo lweNational Action Plan lokulwa namabhaktheriya aphikisana ne-antibiotic.
Ngokusho kokuphatha kuka-Obama, nansi imigomo yalesi sigungu esiphezulu:
- Ukunciphisa Ukuvezwa Kwebhaktheriya Ekulinganiselayo nokuvimbela Ukusakazwa kwezifo eziphikisanayo.
- Qinisa imizamo yokuHlola iNational One-Health Ukulwa Nokuphikiswa.
- Ukuthuthukiswa Kwentuthuko kanye nokusetshenziswa kwezivivinyana zokuhlola okusheshayo nezenzakalelayo zokukhomba nokuhlukaniswa kwamabhaktheriya aphikisayo.
- Ukusheshisa Ucwaningo Nokuthuthukiswa Okuyisisekelo Nokuthuthukiswa Kwama-Antibiotics Amasha, Okunye Ukuhlinzeka Ngokwemithi, Nemithi Yokugoma.
- Thuthukisa ukusebenzisana kwamazwe ngamazwe kanye namakhono okulwa nokulwa nokulwa nokulwa nokulwa nokulwa, ukubhekwa, ukulawulwa, nokulwa nobugebengu be-antibiotic kanye nokuthuthukiswa.
Ukuze ahlangabezane nalezi zinhloso, umongameli wacela usizo lwezinhlangano ezihlukahlukene, kuhlanganise noMnyango Wezokuvikela (DoD), uMnyango Wezolimo (USDA), noMnyango WezeMpilo kanye Nezinsizakalo Zabantu (HHS). Ngo-May 2016, la ma-ejensi akhipha izindaba: i- coli -resistant mcr-1 E. coli yatholwa esigulini ku-Walter Reed Medical Centre e-United States. Lesi siguli sasine- infection ye- urinary tract eyayinenhlanhla ikhono lokuphathwa ngenye imithi elwa namagciwane.
I-Colistin yisidakamizwa sokugcina ekuvikeleni kwethu izifo. Ochwepheshe abaningi bezempilo emphakathini, abacwaningi, kanye nodokotela abafanayo baye besaba ukumelana ne-colisitin isikhathi esithile. Ngaphezu kwalokho, i- mcr-1 E. Coli inamandla okudlulisa lokhu ukumelana namagciwane kwamanye amabhaktheriya esebenzisa i-plasmids.
Kungani Kufanele Ukhathazeke Ngokumelene Nokuphikiswa Kwama-Antibiotic?
Kusukela ngo-1928, ngokusungulwa kwe-penicillin, ama-antibiotics agcinile izimpilo eziningana zezigidi emhlabeni jikelele. Ngokushesha ngemva kokusungulwa kwama-antibiotics, ukuphikiswa phakathi kwezinhlobo ezithile zamabhaktheriya kwaqashelwa. Eminyakeni yamuva, lokhu kumelana kuye kwanda amabhaktheriya amaningi, noma ama-superbugs , abe yingozi enkulu empilweni yomphakathi nokuphepha.
I-CDC ilinganisela ukuthi izifo ezingaba izigidi ezimbili ezibangelwa izidakamizwa zenzeka ngonyaka ngamunye e-United States eziholela ekufeni kwabantu abangaba ngu-23 000.
Njengoba ukuqhuma kwamuva ku- resistance anti-drug , inani lezokwelapha ezisebenza ngokumelene namabhaktheriya anjalo ziye zancipha. Ngaphezu kwalokho, ama-antibiotics enza izidakamizwa ezinokuphikisa angabiza kakhulu.
Yini Colistin?
UColistin ungowesigaba sama antibiotic eyaziwa ngokuthi amapolymyxins. Kunezinhlobo ezimbili zama-polymyxins: i-polymyxin B ne-polymyxin E. Colistin yi-polymyxin E futhi isetshenziswe kakhulu kulaba ababili.
IColistin yaqala ukusetshenziswa ngawo-1960; Kodwa-ke, ukusetshenziswa kwalesi sikhungo kwavalwa masinyane ngenxa yokuthi kwaphumela ekutheni i-neurotoxicity ne-nephrotoxicity. Ngamanye amazwi, i-colistin yabangela ukulimala kwesibindi nezinso, ngokulandelana.
Eminyakeni yamuva ngokunyuka kwama-multi-drug, siye kwadingeka sivuselele i-colistin ukulwa namabhaktheriya manje aphikisana nemithi elwa namagciwane amaningi. I-Colistin iphumelela ngokuphawulekayo kodwa isebenza ngama-bacteria ambalwa, njengeP aeruginosa , izinhlobo ze- Acinetobacter nezinhlobo ze- Klebsiella . Okuphawulayo, zonke lezi zinhlobo ezahlukene zamabhaktheriya zingabangela ukutheleleka kwegazi (sepsis) kanye nezifo zamaphaphu (isibhamu), izifo zokungena emanzini, izifo zesikhumba nezilonda, kanye nokutheleleka ngemva kokuhlinzwa. Ukwengeza, lawa ma-bacteria agula abantu abagula kakhulu futhi bayeke ukuvimbela amasosha omzimba.
Ukudluliselwa kokuphikiswa kwama-antibiotic ngamaplasmids
Yini eyenza le nkinga entsha ye-colistin yokumelana no-E. Coli iwukuthi ingadlulisela ulwazi lwezakhi zofuzo ngokumelana namanye amabhaktheriya nge-plasmids (okungukuthi, i- mcr-1 noma i-plasmid-mediated polymyxin resistance mechanism).
Njengoba kubikiwe i-Lancet ngo-November 2015, abacwaningi baseShayina babenokuqala ukuthola lo mdlalo omusha. Abacwaningi bathola leli bhaktheriya eliphikisanayo ngesikhathi kuhlolwa iphrojekthi yokuhlola ukuhlola ukulwa nokulwa namagciwane phakathi kwe- Escherichia coli esetshenziselwa izilwane ekudleni kokudla.
Phakathi kwesikhashana phakathi kokutholakala kwamaShayina kwalezi zingqikithi kanye nalawa ma-bacteria avela esikhungweni sezempi seWalter Reed, lapho abacwaningi bombuso bebona khona, lokhu kukhishwa kwamanye amazwe kuye kwabonakala kwamanye amazwe amaningi, okusho ukuthi sekuvele kusakazeka emhlabeni wonke.
Ngenhlanhla, uphenyo olulandelwa yi-National Antimicrobial Resistance Monitoring System-umzamo ohlanganyelwe phakathi kwe-USDA, Health and Human Services (HHS), nomnyango wezeMpilo wasekhaya nomphakathi-ubonisa ukuthi ukuhlukaniswa kwamakhemikhali e- E. coli angenqabile . Ngaphezu kwalokho, ukuhlukaniswa kweSalmonella neKlebsiella, ezinye izinhlobo zamabhaktheriya, akubonanga ubufakazi bokuthi igciwane le-mcr-1.
Ukudluliswa kolwazi lofuzo phakathi kwama-bacterium kuyinto enhle kakhulu. Akukhona nje kuphela ukuthi amabhaktheriya adlulisa ulwazi lokufaka ikhodi yokumelana nenzalo-okukhulunywa ngayo njengokudlulisa okuqondile-kodwa amabhaktheriya nawo angadlulisela ulwazi olunjalo ngokusebenzisa ukudluliswa kwezakhi zofuzo. Ngamanye amazwi, ngisho nangemva kokusungulwa kwebhaktheriya kungathatha ulwazi lwezofuzo kusuka kwenye i-bacterium.
Ngokuqondile, le nqubo yokudluliswa kwegciwane ephelele ixhunyaniswa ngamaplasmids, noma izingcezu ezihamba ngokukhululekile ze-DNA encane, eyindilinga, e-double-stranded, ehlukene ne-DNA ye-chromosomal cell. Ama-plasmids aqukethe ulwazi olususa izinzuzo zezakhi zofuzo kuma-bacteria, njengama-antibiotic resistance. Ngokudluliswa kwegciwane okuyi-horizontal, ama-plasmids adluliselwa phakathi kwama-bacterium.
Ake sibeke ukudluliswa kwezakhi zofuzo zokulwa nama-antibiotic ngegciwane ngendlela ebonakalayo (ngokungafani nesici esincane). Cabanga ukuthi ukhona emcimbini kanti omunye umuntu wayenekhono lomlingo wokulwa ne-cyanide. Lekhono lemilingo lalifakwe emakhakheni akhe futhi lingadluliselwa ezinganeni zakhe. Ukwengeza, leli khono lingadluliselwa komunye umuntu ngokumane nje uthathe i-cocktail yakhe. Ngaphambi kokuba wazi, wonke umuntu uthatha isiphuzo sakhe. Ngaphezu kwalokho, abanye abathandana nabo ephathini banemibono yabo yemilingo ebubini, okuyinto ababelana ngayo nabanye ngokusebenzisa ubuthi babo. Ngaphambi kokuba wazi, abanye abathintekayo baye bagcina amasu omelana nabo abasiza ukuba balwe nezinhlobo ezihlukahlukene zezinyosi.
Isiphetho
Isongo esiphila khona sokuthi ukumelana nokugqotshwa kwe-colistin kungase kuzwe ukukhathazeka. Njengomuntu ngamunye, ungenza ingxenye yakho ukunciphisa ukumelana namagciwane ngokuthatha ama-antibiotic kuphela uma udinga. Kumele futhi uqiniseke ukuthi uqedela yonke inkambo yama-antibiotic, ngoba ukuyeka isikhathi ngaphambi kwesikhathi kukhuthaza ukukhula kwezimo ezingamelana nezidakamizwa. Okokugcina, ngoba i- mcr-1 E. Coli kanye namanye amabhaktheriya atholakalayo emikhiqizweni yezinkukhu kanye nezinkukhu, kuhlale kuwumqondo omuhle ukupheka ngokugcwele ukudla kwakho ngaphambi kokusetshenziswa.
Imithombo:
Bhalodi A, uNicolau DP. Izimiso zokwelashwa kwama-antimicrobial kanye ne-Clinical Pharmacology yama-antibiotic. Ku: Hall JB, Schmidt GA, Kress JP. ama-eds. Izimiso Zokunakekelwa Okubalulekile, 4e . ENew York, NY: McGraw-Hill; 2015. Kufinyelelwe ngomhla ka-29 Meyi, 2016.
I-Carroll KC, i-Hobden JA, iMiller S, i-Morse SA, i-Mietzner TA, i-Detrick B, i-Mitchell TG, i-McKerrow JH, i-Sakanari JA. I-Microbial Genetics. Ku: Carroll KC, Hobden JA, Miller S, Morse SA, Mietzner TA, Detrick B, Mitchell TG, McKerrow JH, Sakanari JA. ama-eds. Jawetz, Melnick, & Adelberg's Medical Microbiology, 27e . ENew York, NY: McGraw-Hill; 2015. Kufinyelelwe ngomhla ka-29 Meyi, 2016.
Liu, Yi-Yun et al. Ukuvezwa kwe-plasmid-mediated mechanist resistance MCR-1 ezilwaneni nasezilwaneni zabantu eChina: isifundo sezinto eziphilayo ze-microbiological kanye nama-molecule. I-Lancet Infectious Diseases , Umqulu 16, Issue 2, 161 - 168.
Ram S, Rice Rice Isahluko 144. Izifo ze-Gonococcal. Ku: Longo DL, Fauci AS, Kasper DL, Hauser SL, Jameson J, Loscalzo J. eds. I-Harrison's Principals of Internal Medicine, 18e . ENew York, NY: McGraw-Hill; 2012. Kufinyelelwe ngo-Okthoba 25, 2014.