应对全球耐药感染，是时候了！
2016/5/24 护士学习笔记

     背景提要

     青霉素是首个也是最为广泛使用的抗生素，由亚历山大·弗莱明在1928年偶然发现。亚历山大·弗莱明偶然将没盖儿的葡萄球菌培养皿放置了数天，回来后发现培养皿有菌斑生长，只有一处长了霉斑(青霉素菌)的地方除外。这一偶然发现不仅让弗莱明获得了诺贝尔奖，也给现代医学带来一场革命，出现了挽救生命的抗生素，每年都有数千万人因此得救。

     然而不到90年，我们最依赖的抗生素有了耐药问题，关系到全球能否继续有效地对持续存在的传染病威胁做出公共卫生应对。

    

     但细菌发生变异而对以前可以治疗感染的抗生素耐药时，就称为抗菌素耐药(AMR)。当然，抗菌素耐药在某种程度上，是一种不可避免的自然过程。但在人类和食品生产中普遍滥用和过度使用抗菌素，不仅会加速这一过程，还会让每个国家面临风险。如不立刻采取全球性的协调行动，世界将进入后抗生素时代，到那时，普通的感染会再次变得致命。

     英国的Jim O’Neill爵士本周发表了《全球抗菌素耐药回顾》报告及建议，提出了一个全面行动计划，呼吁不仅是一个国家、而是全世界合力预防耐药感染，战胜日益严重的抗菌素耐药威胁。报告阐述了为什么抗菌素耐药会成为如此严重且日益恶化、需要立刻着手解决的全球问题。抗菌药物的效果日益变差，而新药研发又难以跟上。他认为到2050年，抗菌素耐药每年会导致1000万人死亡，相当于每3秒钟1人，比癌症目前造成的死亡还要多。如果任其发展，可累计造成100万亿美元的经济损失。我们能够承担得起这种不作为的后果吗？(点击下方“阅读原文”，了解报告内容)

     对中国有何意义？

     中国的抗生素用量约占世界的一半，其中48%为人用，其余用于农业。据估计，到2050年，抗生素耐药每年将导致中国100万人早死，累计给中国造成20万亿美元的损失。普遍购买非处方药和过于依赖用抗生素治疗、控制感染和促进牲畜生长，是中国抗生素耐药问题的重要原因。由于存在给患者过度开药的经济激励机制，培养合理使用抗生素的理念并非易事。对农业使用抗生素的监管薄弱也进一步助长了滥用问题。

     我们该如何应对？公众：

     考虑是否真的需要用抗生素治疗(记住：感冒和流感是不能用抗生素治疗的)；

     医生开了抗生素后要用完全程；

     不要把没用完的抗生素给别人用。

    

     医生：

     仅在必要时有选择性地开药；

     支持新型抗生素的研发，这样一旦旧药无效时可以取而代之；

     支持全球公众宣传活动，让患者和同行了解耐药带来的问题和后果。

    

    中国于2016年首次主办了20国集团(G20)会议，这对全球治理是一个历史性的机会。中国有能力从此开始引领全球有效应对抗菌素耐药问题。让我们共同支持全球针对抗菌素耐药的行动!

     不能让亚历山大·弗莱明的幸运发现在不到90年后成为历史。我们可以采取自觉行动，避免让我们最依赖的药物最终只能进入博物馆。我们的世界、我们的子孙后代仍需要抗生素来抗击感染，保持健康。

     世卫组织驻华代表处去年11月首次举办了世界抗生素宣传周活动，希望让大家认识到，我们一定要谨慎使用抗生素，让抗生素尽可能长的保持疗效。欢迎大家积极参与今年11月的抗生素宣传周活动。

    

     Tackling drug-resistant infections globally: Jim O'Neill's final report and recommendations

     Penicillin, one of the first and most widely used antibiotic drugs, was discovered by chance, in 1928, after Alexander Fleming accidentally left a dish of staphylococcus bacteria uncovered for a few days. He returned to find the dish dotted with bacterial growth, apart from one area where a patch of mold (Penicillin notatum) was growing. That chance discovery not only earnt Fleming a Nobel Prize, but also revolutionised modern medicine and led to the development of lifesaving antibiotics which save millions of lives each year.

     However, less than 90 years on resistance to antibiotics, our most relied upon drugs, is threatening the sustainability of an effective, global public health response to the enduring threat from infectious diseases.

     Antimicrobial resistance (AMR) happens when bacteria change and become resistant to the antibiotics used to treat infections. Of course, antimicrobial resistance is, to an extent both natural and inevitable. But the systematic misuse and overuse of these drugs in human medicine and food production are not only accelerating the pace of this evolutionary process, but putting every nation at risk. Without harmonised and immediate action on a global scale, the world is heading towards a post-antibiotic era in which common infections could once again kill.

    

     The UK’s Lord Jim O’Neill this week published a Global Review on AMR setting out his final report and recommendations, providing a comprehensive action plan for not just one single country, but the world collectively, to prevent drug-resistant infections and defeat the rising threat of AMR. The report sets out why AMR is such a huge global problem, that is getting worse - and must be tackled now. Antimicrobial drugs are becoming less effective and the world is not developing enough new ones to keep up. He assesses that by 2050 antimicrobial resistance could be responsible for killing 10 million people a year, the equivalent of 1 person every 3 seconds - more than cancer kills today. The cumulative economic cost of us not acting would be around $100 trillion USD. Can we afford to do nothing? (Please click "Read more" in below to read the full report)

     So how is this relevant to China?

     China uses around half the world’s antibiotics, of which 48% are consumed by people and the rest, are used in the agricultural sector. It is estimated that by 2050, antibiotic resistance could result in 1 million premature deaths annually in China and cost the country a cumulative US$20 trillion USD. Antibiotic resistance in China is driven by ubiquitous over-the-counter purchase and an over-reliance on antibiotics for treatment, infection prevention and grown promotion in animals. Rational use of antibiotics is difficult to instil, as financial incentives are offered to overprescribe medication to patients. Weak regulation on the use of antibiotics in agriculture also further encourages overuse.

    

     So what can you do about this?For the general public:

     Ask yourself if you really need antibiotics to treat your illness (remember that colds and flu cannot be treated by antibiotics);

     Use a full course when prescribed antibiotics;

     Don’t share unused antibiotics.

     If you are a doctor:

     Prescribe selectively and only when necessary;

     Support the supply of new antibiotics so they can replace existing ones as they become ineffective.

     Support a global public awareness campaign to educate patients and colleagues about the problem and consequences of drug resistance.

     It is a historic opportunity for global governance that China is hosting the G20 in 2016 for the first time; it is in China’s power to lead the world in tackling the AMR problem meaningfully and globally from its presidency onwards. Let’s support global action on tackling resistance to antimicrobial drugs!

    

     Don’t let Alexander Fleming’s chance discovery be a thing of the past, less than 90 years on. We can all take conscious steps to prevent our most relied upon drugs ending up in a museum. The world, our children and our grandchildren still need antibiotics to help them fight infections and stay healthy.

     WHO China held the first World Antibiotics Awareness Week last year in November and helped raise awareness that we must handle antibiotics with care so they remain effective for as long as possible. Play your part and join us this for this year’s Antibiotic Awareness Week in November 2016.

     来源 世界卫生组织公众号

    

    

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