Kusakwanisa kurwisa mabhakitiriya (AMR) kwave chimwe chezvinhu zvikuru zvinotyisidzira hutano hwevanhu pasi rose.

Chidzidzo chakakosha chakaburitswa muLancetakafungidzira kutiVanhu vanosvika mamiriyoni 1.27 vakafa muna 2019 nekuda kwekusakwanisa kurwisa mabhakitiriya (AMR), uku vava kudaVanhu mamiriyoni mashanu vakafa vakabatana neAMR yebhakitiriyaZvinoshamisa kuti,73% yerufu runokonzerwa neAMR rwakakonzerwa nehutachiona hutanhatu chete., zvichisimbisa kudiwa kukuru kwekutarisa zvinobudirira, kudzivirira hutachiona, kutarisira mishonga inorwisa utachiona, uye kuongororwa nekukurumidza.

Pakati pezvirwere izvi, mabhakitiriya matatu eGram-negative anofanirwa kutariswa zvakanyanya:

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

Utachiona uhu huri kuramba huchirwisa carbapenems—chinhu chakakosha pakurapa hutachiona hwakawanda hwakakomba hweGram-negative—uye hunoonekwa pasi rose sehutachiona hunonyanya kukosheswa.

WHO Inoti Utachiona Uhu Hune Zvakakoshakana Zvinhu Zvikuru Zvinokosheswa

IyoRondedzero yeUtachiona Hunonyanya Kukosha hweMabhakitiriya yeWHO (BPPL) 2024inoziva mabhakitiriya asingaurayiwi nemishonga inorwisa utachiona anoda mari nekukurumidza mukuongorora, mishonga, majekiseni, uye nzira dzekudzivirira hutachiona.

Pakati peKutsoropodza/YakakwiriraKukoshesautachiona ndeidzi:

• · Inodzivirira CarbapenemAcinetobacter baumannii(KARABHU)
• · Inodzivirira CarbapenemPseudomonas aeruginosa(CRPA)
• · Enterobacteriales (CRE) inodzivirira carbapenem, kusanganisiraKlebsiella pneumoniae(CRKP)

WHO inoenderera mberi ichisimbisa kuti kurwisa utachiona uhu kunoda nzira yakazara yekubatanidzakuongororwa nekukurumidza, kutarisa, kutarisira mishonga inorwisa utachiona (AMS), uye kudzivirira nekudzivirira hutachiona (IPC)pane kungovimba nekugadzirwa kwemishonga mitsva inorwisa mabhakitiriya chete.

Nhungamiro Dzepasi Pose Dzinoratidza Kukosha Kwekuongorora Chirwere Nekukurumidza

Kurwisa AMR kunoda zvinopfuura mishonga inorwisa mabhakitiriya inoshanda chete—zvinoenderana nekuongororwa kwakakodzera uye nenguva.

IyoChirongwa cheWHO cheGlobal Action pamusoro peKusagona Kurwisa Mabhakitiriyainocherechedza kusimbisa kugona kwemurabhoritari uye kuwedzera mukana wekuwana kuongororwa kwemhando yepamusoro sezvinhu zvakakosha pakuvandudza kutarisa uye kugadzirisa kushandiswa kwemishonga inorwisa utachiona.

Kuvakira pane iyi nzira, iyoChirongwa cheWHO chekuongorora Kusagadzikana kweMabhakitiriya (2024)inoratidza kukurumidza kuongororwa kwechirwere senzira yakakosha yeku:

• · Tsigira kutarisira mishonga inorwisa utachiona (AMS)
• · Kutungamira kurapwa kwemishonga inorwisa utachiona panguva yakakodzera uye yakakodzera
• · Ita kuti kudzivirira nekudzivirira hutachiona (IPC) kushande
• · Simbisai kutariswa kweAMR
• · Kuvandudza kuonekwa kwechirwere uye kupindura kwacho
• 

Saizvozvowo,Sangano reZvirwere Zvinotapukira reAmerica (IDSA)inokurudzira kukurumidza kuongorora mamorekuru, kana kuripo, kuti vaone utachiona hwemabhakitiriya uye nzira dzekusarwisa utachiona nekukurumidza, zvichibvumira vanachiremba kuti vashandise kurapa kwemishonga inorwisa mabhakitiriya zvakanaka uye kuderedza kusangana nemishonga inorwisa mabhakitiriya ine hutachiona hwakakura.

IyoSangano reEuropean Society of Clinical Microbiology and Infectious Diseases (ESCMID)vanokurudzirawo kuziva nekukurumidza mabhakitiriya eGram-negative anogadzira carbapenase kuti zvibatsire kutanga kushandisa matanho ekudzivirira hutachiona uye kurapwa kwakakodzera kwemishonga inorwisa utachiona.

Pamwe chete, mazano aya epasi rose anosimbisa shoko rimwe chete:Kuongororwa kwemamorekuru nekukurumidza kuri kuva chinhu chakakosha mukutarisira kweAMR kwemazuva ano.

Kunzwisisa KPN, Aba nePA

Klebsiella pneumoniae (KPN)

K. pneumoniaendiyo honzeri huru yepneumonia inokonzerwa nehutano, hutachiona hweropa, hutachiona hwemunzira yeweti, uye sepsis.

Inodzivirira CarbapenemK. pneumoniaeKazhinji inotakura majini ecarbapenemase anosanganisira: KPC, NDM, OXA-48-like uye IMP.

Marudzi ehutachiona hunowedzera hutachiona anogona kusanganisa hutachiona hwakanyanya pamwe nekurapwa kwemishonga yakawanda, zvichikonzera matambudziko makuru ekurapa.

Acinetobacter baumannii (Aba)

A. baumanniiinotsungirira zvakanyanya uye inokwanisa kugara panzvimbo dzakatikomberedza kwenguva yakareba.

Inobatanidzwa zvakanyanya ne:

• · Kupararira kweICU
• · Mapundu ane chekuita nekufema (VAP)
• · Utachiona hweropa
• · Utachiona hunokonzerwa nemidziyo

Kukwanisa kwayo kuwana zvinhu zvinokonzera kusasimba kwemuviri kwakaita kuti irambe kurwisa carbapenemA. baumanniichimwe chezvirwere zvakaoma kurapa muchipatara.

Pseudomonas aeruginosa (PA)

P. aeruginosaihutachiona hunokanganisa vanhu vane chirwere ichi uye hunowanzo kanganisa varwere vane dziviriro yemuviri inovakanganisa.

Kusagona kurwisa utachiona, kukurumidza kuchinja majini, uye kugadzirwa kwe biofilm zvinobatsira mukutapurirana kusingaperi uye kuwedzera kusagona kurwisa carbapenem pasi rese.

Kutapurirana muZvirongwa zveHutano

Utachiona uhu husingapindi mishonga yakawanda hunonyanya kutapuriranwa kuburikidza ne:

• · Midziyo yekurapa yakasvibiswa nenzvimbo dzezvakatipoteredza
• Maoko evashandi vehutano
• · Varwere vane colony kana kuti vane hutachiona
• · Zvinobuda mukufema
• · Zvishandiso zvinopinda muropa zvakaita semafenzi ekufema necatheter

Zvinoenderana neNzvimbo dzeUS dzeKudzora neKudzivirira Zvirwere (CDC), kuwanikwa kwekutanga kwemurabhoritari pamwe chete nekutarisira mishonga inorwisa utachiona uye matanho akasimba ekudzivirira hutachiona zvakakosha pakuderedza kutapurirana kwehutachiona husingarapike nemishonga yakawanda hunoenderana nehutano.

Matambudziko Ekurapwa

Nzira dzekurapa dziri kuramba dzichiwedzera kuva shoma.

Matambudziko aripo iye zvino anosanganisira:

• · Kuwedzera kuramba kwe carbapenem
• · Kuwanikwa kwemishonga mitsva inorwisa utachiona kushoma
• · Huturu hunokonzerwa nepolymyxins
• · Kuramba kuripo kune zvinhu zvitsva

Nekuda kweizvozvo, nhungamiro dzepasi rose dzinogara dzichikurudzira kuwana humbowo hwezvinhu zvipenyu panguva yakakodzera kuti hutsigire kurapwa kwemishonga inorwisa utachiona pese pazvinogoneka.

Nei Kukurumidza Kuonekwa Kwemamorekuru Kuchikosha

Kuongororwa kwetsika dzechinyakare uye kuyedzwa kwehutachiona hwehutachiona zvinowanzodaMaawa 48–72usati wawana mhinduro dzinoshanda.

Kuongororwa kwemamorekuru nekukurumidza kunogona kupfupisa nguva iyi zvakanyanya nekuona panguva imwe chete hutachiona uye majini ekudzivirira akakosha mukiriniki, zvichiita kuti zviitike pakutanga:

• · Kurapa kwakakodzera kwemishonga inorwisa utachiona
• · Kudzivirira hutachiona
• · Sarudzo dzekutarisira mabhakitiriya
• · Kuongororwa kwezvipenyu zvisingatsungiriri

Mhinduro yeMultiplex PCR yekuita sarudzo dzekiriniki nekukurumidza

Kuti titsigire kukurumidza kuziva hutachiona hweGram-negative hwakakosha mukurapa uye nzira dzekudzivirira carbapenem,Macro & Micro-Test's KPN, Aba, PA & Drug Resistance Genes Multiplex Detection Kitpanguva imwe chete inoona:

Utachiona hwakanangana: Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa 

Majini eCarbapenase: KPC, NDM, OXA-48, IMP

Zvinhu Zvikuru

• · Kuonekwa zvakananga kubva muzvinwiwa zvemakonzo
• · Hapana kudiwa kwenguva refu kwekuvandudza tsika
• · Kunzwisisa kwekuongorora:LoD 1000 CFU/mL 
• · Mhedzisiro inowanikwa muMaminetsi 35–50 
• · Inoenderana nemapuratifomu ePCR akakurumbira panguva chaiyo

Nekupa kukurumidza kuziva mamorekuru ezvirwere zvinotapukira uye zviratidzo zvekusagona kudzivirira utachiona, bvunzo iyi inogona kuwedzera mashandiro echinyakare e microbiology uye kutsigira sarudzo dzekiriniki dzekare.

Kushanda Pamwe Chete Mukurwisa AMR

Kusakwanisa kurwisa mabhakitiriya hakugone kukundwa kuburikidza nemishonga mitsva inorwisa mabhakitiriya chete.

IyoWHO, IDSA, ESCMIDuyeCDCZvinogara zvichisimbisa kuti kudzora AMR kunoshanda kunoda kubatanidzwa kwe:

• · Kuongorora nekukurumidza
• · Kutarisira mishonga inorwisa mabhakitiriya
• · Kudzivirira uye kudzora hutachiona
• · Kuongororwa kwemurabhoritari
• · Kupindira kwekiriniki nenguva

Sezvo marabhoritari pasi rose achiramba achisimbisa mhinduro yawo yeAMR, kuongororwa kwemamorekuru nekukurumidza kunogona kuita basa rakakosha mukutsigira sarudzo dzekurapa dzakavakirwa pauchapupu uye kubatsira kuderedza kupararira kwezvirwere zvisingaurayiwi nemishonga.

Mareferensi

1. Vanoshanda pamwe chete neAntimicrobial Resistance.Mutoro wepasi rose wekusagona kurwisa mabhakitiriya mukurwisa mabhakitiriya muna 2019. Lancet. (Zvinyorwa zveLancet).2022.

2. Sangano reHutano rePasirose.Chirongwa Chenyika Yose Chekurwisa Kusashanda Kwemishonga Inorwisa Mabhakitiriya.2015.

3. Sangano reHutano rePasirose.Rondedzero yeUtachiona Hunokosheswa neMabhakitiriya yeWHO 2024. 

4. Sangano reHutano rePasirose.Chirongwa Chekuongorora Kusabatwa Nehutachiona.2024.

5. Sangano reZvirwere Zvinotapukira reAmerica (IDSA).2024 Gwaro reKurapa Utachiona Husingapindi Mushonga weGram-Negative. 

6. European Society of Clinical Microbiology and Infectious Diseases (ESCMID).Nhungamiro dzeKutarisira Utachiona Hunokonzerwa neMultidrug-Resistant Gram-Negative Bacilli. 

7. Nzvimbo dzeUS dzeKudzora neKudzivirira Zvirwere (CDC).Zvipingamupinyi zveKusakwanisa Kurwisa Mishonga Inorwisa Mabhakitiriya muUnited States.