国际和国内细菌耐药监测研究介绍

【作者】 吕媛； 李耘； 郑波；

【机构】 北京大学第一医院临床药理研究所；

【摘要】 细菌耐药已成为全球范围的重大公共健康问题,而抗菌药物的广泛使用是造成细菌耐药的重要因素之一。不可否认停用抗菌药物一段时间后细菌耐药性会有所下降,但这种途径不可取。由于新型抗菌药物开发速度日渐减慢,我们只能将目光转向已有抗菌药物的合理使用上。实现抗菌药物的合理使用,需要对于细菌耐药机制,细菌耐药发展趋势及细菌耐药与抗生素应用关系等知识的了解。而细菌耐药监测为我们打开了获取这些信息的大门。非但如此,耐药监测在改进现有治疗,提高评价介入措施的质量,甚至新药物的研发等方面都会给我们提供新思路。耐药监测有多种类型,有不同的主办者,不同的规模,以及不同的监测对象。耐药监测的内容也是多方面的,其中,对于细菌耐药性产生及抗菌药物应用关系的研究可谓重中之重。本文简单介绍了国际上最具影响力的一些监测项目,并提到了它们各自的特点及优势。从中可以看到,依据监测目的的不同,监测研究采用的方法,规模,监测对象不尽相同。但耐药监测也存在一定问题,如多个单位参加的细菌耐药监测存在方法标准化和实验室标准化问题。目前,多数监测研究尚没有涉及到抗菌药物应用情况以及量化研究。因此,仍应进一步努力提高耐药监测的质量,努力建立通用的标准。更多还原

【Abstract】 Antimicrobial resistance is a major public health concern worldwide,which can largely be attributed to widespread antimicrobial use.The complete withdrawal of antimicrobial exposure might yield dramatic reductions in resistance over a period of years,but such a goal is not justifiable because there will always be patients with legitimate need for therapy.Judicious use of antimicrobials may at least slow the spread of resistant pathogens,improve the quality of health care and help prevent adverse events.Proper use of antimicrobials should be based on knowledge of mechanisms of resistance,relationship between resistance emergence and antimicrobial application,and good predictions of trend of resistance development.All of these cannot be obtained without resistance surveillance.Besides,resistance surveillance will provide us with new sights of improvement of existing therapy,better evaluations of interventions as well as development of novel antimicrobials.There are many categories of such surveillance programs with different sponsors,a wide range of scales and various objects(specific group of people,isolates(?)drugs and so on).They also cover a great amount of contents with survey of relationship between resistance occurrence and antimicrobial use as the most important section.This article presents with a brief introduction of most influential international institutes of resistance surveillance,including their individual features and advantages.It is obvious different surveillance adopted different methods,scales and objects according to different purposes of surveillance. However,there exist many problems in resistance surveillance.They include problems involving standardization of methods and laboratories used in multi-unit resistance surveillances.At present,many surveillances failed to cover antimicrobial application or necessary quantitative investigations.Therefore,further efforts should be made to improve quality of resistance surveillance and establish common standards.更多还原