多重耐药菌的监控与新抗生素研发

Monitoring of the Multiple Resistant Bacteria and Development of New Antibiotics

目的介绍目前我国多重耐药菌的基本现状,分析多重耐药菌的产生、传播情况,探讨我国应对细菌多重耐药措施的思考。方法收集、检索国内外近年有关细菌多重耐药的文献报道、课题总结和案例报告,归纳、分析、评估当前我国细菌多重耐药的严峻形势,并对可能的原因进行分析,调研国外相关成功经验,探讨我国应对细菌多重耐药的基本思路。结果目前我国细菌耐药的重点依然为耐甲氧西林的葡萄球菌、耐β-内酰胺类和大环内酯类抗生素的多重耐药肺炎链球菌、产超广谱β-内酰胺酶及AmpC酶的革兰阴性杆菌和非发酵糖菌群的多重耐药菌等。动物饲养、食品保鲜等领域过度添加抗生素,抗生素生产企业随意排放含有高浓度抗生素的废渣,临床治疗领域长期、反复、无原则、大剂量地使用抗生素,均导致了人类活动空间抗生素浓度的持续增加,成为诱发耐药菌产生并促使其蔓延的主要原因。结论建议加强多重耐药菌的监控,密切关注其发展趋势;引导、强化抗耐药菌抗生素,尤其对革兰阴性MDR菌敏感的新抗生素研发;同时加强各部门的协同力度,建立国内抗耐药菌抗生素生产、供应信息数据库,预测突发耐药菌感染时的药物可及性;并从药物研发到生产、供应等各个环节制定应急预案,做到未雨绸缪。

OBJECTIVE To introduce introduce the basic current status of multiple resistant bacteria in our country, analyze the production and transmission situations of multiple resistant bacteria and discuss the thoughts of our country for the countermeasures for the multiple resistant bacteria. METHODS To collect and retrieve the literature reports, subject summary and case report related to the multiple drug resistance of bacteria both at home and abroad. Summarize, analyze and evaluate the current grim situation for multiple drug resistance in our country as well as analyze the possible reasons, investigate the related successful experience abroad and discuss the basic idea of our country against multiple drug resistance of bacteria. RESULTS At present, the focus for drug resistance of bacteria in China is still the multiple drug resistance of the methicillin-resistant staphylococcus, streptococcus pneumoniae which is multiple resistant to β-lactams and macrolides and gram-negative bacilli which produce super-broad spectrum β-lactamase and AmpC enzyme and non-fermenting sugar flora. Excessive addition of antibiotics in animal feeding and food fresh keeping, waste residue with high concentration of antibiotics arbitrarily discharged by the manufacturers of antibiotics and long-term, repeated, unprincipled and large dose use of antibiotics in clinical treatment field have resulted in the continuous increasing of antibiotics concentration in human activity space which has become the main reason for the production of drug resistant bacteria as well as promotion of the spread of drug resistance bacteria. CONCLUSION It is suggested to strengthen the monitoring for multiple resistance bacteria and pay close attention to its development trend, guide and intensify the development for new antibiotics, especially those which are sensitive to gram-negative MDR bacteria. At the same time strengthen the cooperation between each department, establish the production and supply information database of antibiotics for drug resistant bacteria in the country and predict the drug accessibility when sudden drug resistant bacteria infections occur. Establish the contingency plan from the development to production and supply steps of the drug to plan ahead.