Drug resistant bacteria refer to those with drug resistancePathogen。In the long runantibioticThe selected microorganisms that are resistant to the corresponding antibiotics are collectively referred to as drug-resistant bacteria.So called bacterialDrug resistanceIt refers to that the sensitivity of bacteria to drugs decreases or even disappears after repeated contact with drugs, resulting in reduced or even ineffective efficacy of drugs against drug-resistant bacteria.The emergence of drug-resistant bacteria has increased the difficulty of curing infectious diseases, and forced humans to find new ways to fight microbial infection.
Drug resistant bacteria are mainly caused by improper use of antibiotics[1]。In the 1940s,penicillinAs the first antibiotic used in clinic, it has successfully solved the problem ofStaphylococcus aureusInfection is a difficult problem.LaterMacrolides，Aminoglycoside antibioticsAgainpneumonia、pulmonary tuberculosisAt that time, it was asserted that the era of human beings defeating bacteria had come.However, the fact is not as beautiful as people think. Many antibiotics have reduced their efficacy to varying degrees after years of application,Natural penicillinIt has almost lost its medicinal value in controlling Staphylococcus aureus infection.After studying this phenomenon, medical experts were surprised to find that after many times of contact with antibiotics, bacteria have evolved a set of effective drug resistance mechanisms, and the hidden enemy of drug resistant bacteria is gradually becoming stronger.
Difficulty in medication
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In the 1950s and 1960s, known as the "golden age" of antibiotics, the world died every yearInfectious diseasesThe number of people is about 7 million, which rose to 20 million in 1999.In the United States, known as the most technologically advanced country in the world, the number of deaths from infectious diseases increased by 40% between 1982 and 1992septicemiaThe number of people increased by 89%.causeCase fatality rateThe main reason for the increase is the difficulty of drug use caused by drug-resistant bacteria.
Bacterial evolution
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Like other organisms in nature, bacterial genes also undergo random mutations in evolution.Antibiotic sensitive bacteria are killed, andGene mutationThe insensitive bacteria may survive after repeated“engagement”The surviving bacteria have accumulated rich "combat experience" and become variant varieties.For example, Pseudomonas aeruginosa can change the permeability of cell membrane and prevent the entry of penicillin drugs;Mycobacterium tuberculosisBy changing the bodyprotein structurePrevent the combination of antibiotics;What's more, someGram negative bacteriaIt can attack actively and hydrolyze with hydrolasepenicillinandCephalosporinsDrugs.Bacteria can not only pass on the mutated gene to the next generation, but also through direct contact,plasmidTransferDrug resistanceIt was passed to a different strain, which caused great headaches for medical experts.
Causes
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Abuse of antibiotics is the main reason for the emergence of a large number of drug-resistant bacteria.Before 1993, the United States issued 70 million prescriptions containing antibiotics every day, and almost all diseases suspected of bacterial infection were treated with antibiotics.Cold, enteritisamygdalitisAre listed as indications for antibiotics;In surgery, because infection can affect the beauty of wound healing, even the smallest surgery should be injected with antibiotics in advance in case.Such abuse of antibiotics is like a trial for bacteria, which greatly accelerates the pace of its evolution.
For a long time, bacterialDrug resistanceNot enough attention has been paid. Doctors believe that the existing drugs are more than enough to deal with drug-resistant bacteria.For example, yesNatural penicillinDrug resistant Staphylococcus aureus can be usedAmpicillin；When ampicillin is ineffective, it can also be usedcephalosporin；Even resistance to cephalosporin resistanceMethicillinStaphylococcus aureus (MRSA), people still have the last line of defense——vancomycin。However, in 1992, the United States first discovered MRSA, which can be resistant to vancomycin, which almost forced doctors into an embarrassing situation of no drug available.
Use antibiotics with caution
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In China, the abuse of antibiotics is also very common. According to the survey, about 75% of our outpatient cold patients use antibiotics, while surgeryPerioperative periodThe use of antibiotics is as high as 95%.Among in-patients, the rate of antibiotic use was 79%, which was far higher than 22% in the UK and 30% in the average level in various countries.At the same time, due to the abuse of doctorsampicillinAnd other broad-spectrum antibacterial drugs, resulting inDysbacteriosisAnd induceSecondary infectionThe situation is even more common.One thing different from the United States is that many of our in-service doctors have not updated their knowledge. Their knowledge about antibiotics is far out of date. Some doctors prescribe drugs based on experience and still use themNatural penicillindeal withDrug resistanceIt has already reached 98% of Staphylococcus aureus.In addition, some hospitals do notDrug susceptibility testThe use of antibiotics is also very serious.Drug sensitivity test is an important step to determine which antibiotics bacteria are sensitive to. Medication without this step is like fighting an unprepared battle, and its effect is conceivable.
The problem of drug-resistant bacteria in China has become very prominentNosocomial infectionThe number of infected patients has accounted for about 30% of the total number of infected patients in hospitalBacterial resistanceThe issue is already a top priority.
Based on China's national conditions, strengthening on-the-job education for clinicians, establishing dynamic monitoring of bacterial resistance and accelerating the development of new antibiotics are all feasible measures to solve the problem of drug-resistant bacteria, but the key to solving this problem is still how to eliminate the abuse of antibiotics.Since 1993, the United States passed legislation to restrict the use of antibioticsStrainsThe emergence of antibiotics has been greatly reduced, and the existing antibiotics can basically meet the clinical needs, which shows that the role of laws and regulations cannot be ignored.For the masses of the people, it should be clear that careful use of antibiotics is not only for their own consideration, but also for the health of our future generations.Many patients take antibiotics according to their own feelings, or they do not follow the doctor's advice to reduce the amount of medicine and the number of times they take medicine at will, which is incorrect behavior.Bacteria are like weeds. If they cannot be completely killed at one time, they will soon come back.
1. Strengthen the standardized construction of clinical microbiology (department) and improve the ability, efficiency and accuracy of pathogenic diagnosis.Equipped with corresponding equipment andProfessional techniciansStrengthen training, improve diagnostic methods, formulate various laboratory guidelines, and improve the level of pathogenic diagnosis and drug resistant bacteria detection.
2. The hospital strictly implements the disinfection and isolation system to prevent cross infection of drug-resistant bacteria in the hospital.Strictly implement health management, strengthen aseptic operation, disinfection isolation and drug resistant bacteria prevention and control in hospitals to reducenosocomial infectionTo correct the concept and medical behavior of excessive dependence on antibiotics to prevent infection[3]。
