Ukumelana neentsholongwane (i-AMR) kube yenye yezona zinto zisongela impilo yoluntu kwihlabathi liphela.

Uphononongo olubalulekileyo olupapashwe kwiI-Lancetkuqikelelwa ukubaAbantu abayi-1.27 yezigidi ababhubhileyo ngo-2019 babangelwa ngokuthe ngqo kukunganyamezelani neentsholongwane ezibangelwa ziintsholongwane (i-AMR), ngelixa phantseAbantu abazizigidi ezi-5 ababhubhileyo banxulunyaniswa ne-AMR yebhaktiriyaOkumangalisayo kukuba,Ama-73% okufa okubangelwa yi-AMR abangelwa ziintsholongwane ezintandathu kuphela., nto leyo egxininisa imfuneko engxamisekileyo yokubeka esweni ngempumelelo, ukuthintela usulelo, ulawulo lweentsholongwane, kunye nokuxilongwa ngokukhawuleza.

Phakathi kwezi ntsholongwane, iintsholongwane ezintathu zeGram-negative zifanelwe ingqalelo ekhethekileyo:

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

Ezi zinto eziphilayo ziya zixhathisa ngakumbi kwi-carbapenems—isiseko sonyango lwezifo ezininzi ezinobungozi zeGram-negative—kwaye zibonwa kwihlabathi liphela njengeentsholongwane eziphambili.

I-WHO ichonga ezi zifo njengezibalulekileyookanye Izinto Ezibalulekileyo

IUluhlu lweePathogens eziPhambili zeBhaktheriya ze-WHO (BPPL) 2024ichonga iibhaktheriya ezimelana neentsholongwane ezifuna utyalo-mali olukhawulezileyo kwiindlela ezintsha zokuxilonga, unyango, izitofu, kunye namaqhinga okuthintela usulelo.

PhakathiOkubalulekileyo/PhezuluOkubalulekileyoIintsholongwane zezi:

• · Ayina-carbapenemI-Acinetobacter baumannii(UNONKALA)
• · Ayina-carbapenemI-Pseudomonas aeruginosa(i-CRPA)
• · Ii-Enterobacteriales (CRE) ezingamelaniyo neCarbapenem, kuqukaI-Klebsiella pneumoniae(CRKP)

I-WHO igxininisa ngakumbi ukuba ukulwa nezi zifo kufuna indlela ebanzi yokudibanisaukuxilongwa ngokukhawuleza, ukujongwa, ukuphathwa kweentsholongwane (i-AMS), kunye nokuthintela nokulawula usulelo (i-IPC)endaweni yokuthembela kuphela kuphuhliso lwee-antibiotics ezintsha.

Izikhokelo Zamazwe Ngamazwe Zigxininisa Ukubaluleka Kokuxilongwa Okukhawulezileyo

Ukulwa ne-AMR kufuna okungaphezulu nje kwee-antibiotics ezisebenzayo—kuxhomekeke ekuxilongweni ngexesha elifanelekileyo nangokuchanekileyo.

IIsicwangciso se-WHO seHlabathi liphela sokunganyamezelani neentsholongwaneichonga ukomelezwa kwamandla elebhu kunye nokwandisa ukufikelela kwiingxaki zokuxilongwa ezisemgangathweni njengezona zinto ziphambili ekuphuculeni ukubekwa kweliso kunye nokuphucula ukusetyenziswa kweentsholongwane.

Ukwakhela phezu kwesi sicwangciso,Iphulo le-WHO lokuFumanisa ukuChasana nokuNgena kweeNtsholongwane (2024)igxininisa ukuxilongwa ngokukhawuleza njengesixhobo esibalulekileyo:

• · Ukuxhasa ulawulo lweentsholongwane (i-AMS)
• · Isikhokelo sonyango oluchanekileyo nolufanelekileyo lokulwa neentsholongwane
• · Vumela uthintelo nolawulo losulelo (IPC)
• · Qinisa ukubekwa kweliso kwi-AMR
• · Ukuphucula ukubonwa nokuphendulwa kwesifo esiqhambukayo
• 

Ngokufanayo,Umbutho weZifo eziSulelayo waseMelika (IDSA)icebisa ukuxilongwa ngokukhawuleza kweemolekyuli, apho kufumaneka khona, ukuchonga iintsholongwane ezibangela iintsholongwane kunye neendlela zokuxhathisa kwangethuba, okuvumela oogqirha ukuba baphucule unyango lwe-antimicrobial kwaye banciphise ukuvezwa okungeyomfuneko kwii-antibiotics ze-broad-spectrum.

II-European Society of Clinical Microbiology and Infectious Diseases (ESCMID)ikwacebisa ukuba kuchongwe ngokukhawuleza iintsholongwane zeGram-negative ezivelisa i-carbapenase ukuze kube lula ukuqaliswa kwangoko kwamanyathelo okulawula usulelo kunye nonyango olufanelekileyo lokulwa neentsholongwane.

Xa zizonke, ezi ngcebiso zamazwe ngamazwe ziqinisa umyalezo ofanayo:Ukuxilongwa ngokukhawuleza kweemolekyuli kuba yinxalenye ebalulekileyo yolawulo lwe-AMR lwanamhlanje.

Ukuqonda i-KPN, i-Aba kunye ne-PA

I-Klebsiella pneumoniae (KPN)

I-K. pneumoniaeyimbangela ephambili ye-pneumonia enxulumene nezempilo, usulelo lwegazi, usulelo lomchamo, kunye ne-sepsis.

Ayimelani neCarbapenemI-K. pneumoniaeIhlala ithwala iijini ze-carbapenemase kuquka: i-KPC, i-NDM, i-OXA-48-like kunye ne-IMP.

Iintlobo ze-hypervirulent zinokudibanisa ukwanda kwe-virulence kunye nokuxhathisa amayeza amaninzi, nto leyo edala imingeni ebalulekileyo yonyango.

I-Acinetobacter baumannii (Aba)

A. baumanniiiyakwazi ukumelana neemeko ezinzima kwaye iyakwazi ukuhlala ixesha elide kwindawo engqongileyo.

Inxulunyaniswa kakhulu ne:

• · Ukuqhambuka kwezifo ze-ICU
• · I-pneumonia enxulumene nomoya (VAP)
• · Usulelo lwegazi
• · Iintsholongwane ezinxulumene nezixhobo

Amandla ayo amangalisayo okufumana izinto ezibangela ukuxhathisa zenze ukuba i-carbapenem ikwazi ukumelana nayoA. baumanniienye yezona zifo zibangela ubunzima esibhedlele ukunyanga.

I-Pseudomonas aeruginosa (PA)

I-P. aeruginosayintsholongwane enobungozi edla ngokusulela izigulane ezigula kakhulu nezinamajoni omzimba abuthathaka.

Ukuxhathisa okungaphakathi, ukuziqhelanisa ngokukhawuleza kwemfuza, kunye nokwakheka kwe-biofilm kunegalelo ekusulelekeni okungapheliyo kunye nokwandisa ukuxhathisa kwe-carbapenem kwihlabathi liphela.

Ukudluliselwa kwiSetingi zezeMpilo

Ezi pathogens ezinganyangekiyo ngamayeza amaninzi zidluliselwa ikakhulu ngezi zinto zilandelayo:

• · Izixhobo zonyango kunye neendawo ezingcolisiweyo
• · Izandla zabasebenzi bezempilo
• · Izigulane ezikwikoloni okanye ezineentsholongwane
• · Iincindi zokuphefumla
• · Izixhobo ezihlaselayo ezifana nee-ventilators kunye nee-catheters

Ngokutsho kweAmaziko ase-US oLawulo lweZifo kunye nokuThintela (i-CDC), ukufunyanwa kwangoko kwelebhu kunye nokugcinwa kweentsholongwane kunye namanyathelo angqongqo okuthintela usulelo kubalulekile ekunciphiseni ukudluliselwa kwezinto eziphilayo ezinganyangekiyo ngamayeza amaninzi ezinxulumene nempilo.

Imingeni yoNyango

Iindlela zonyango ziyaqhubeka nokunqongophala.

Imingeni ekhoyo ngoku iquka:

• · Ukwanda kokumelana ne-carbapenem
• · Ukunqongophala kokufumaneka kwamayeza okubulala iintsholongwane amatsha
• · Ubuthi obunxulunyaniswa neepolymyxins
• · Ukuchasana okukhulayo kwiiarhente ezintsha

Ngenxa yoko, izikhokelo zamazwe ngamazwe zihlala zicebisa ukufumana ubungqina be-microbiological ngexesha elifanelekileyo ukuxhasa unyango olujoliswe kwi-antimicrobial nanini na kunokwenzeka.

Kutheni Kubalulekile Ukufumanisa Iimolekyuli Ngokukhawuleza

Uvavanyo lwenkcubeko oluqhelekileyo kunye nokuchaphazeleka kokulwa neentsholongwane ludla ngokufunaIiyure ezingama-48–72ngaphambi kokuba kufumaneke iziphumo ezinokwenzeka.

Ukuxilongwa ngokukhawuleza kweemolekyuli kunokunciphisa kakhulu eli xesha ngokuchonga ngaxeshanye iintsholongwane kunye ne-genes yokumelana nezifo ezibalulekileyo, okuvumela kwangaphambili:

• · Unyango olufanelekileyo lokulwa neentsholongwane
• · Amanyathelo okuthintela usulelo
• · Izigqibo zolawulo lwe-antimicrobial
• · Ukubekwa esweni kwezinto eziphilayo ezinganyangekiyo

Isisombululo se-Multiplex PCR sokwenza izigqibo ngokukhawuleza kwezonyango

Ukuxhasa ukuchongwa ngokukhawuleza kwezifo ezibangela i-Gram-negative kunye neendlela zokuxhathisa i-carbapenem,Ikhithi yokuFumana i-Macro kunye ne-Micro-Test's KPN, Aba, PA kunye ne-Drug Resistance Genes Multiplexngaxeshanye ifumanisa:

Iintsholongwane ezijoliswe kuzo: I-Klebsiella pneumoniae, I-Acinetobacter baumannii, I-Pseudomonas aeruginosa 

I-Carbapenemase genes: I-KPC, I-NDM, I-OXA-48, I-IMP

Ezona mpawu

• · Ukufunyanwa ngokuthe ngqo kwiisampuli zesikhohlela
• · Akukho mfuneko yokutyebisa inkcubeko ixesha elide
• · Uvakalelo lohlalutyo:I-LoD 1000 CFU/mL 
• · Iziphumo ziyafumaneka kwiImizuzu engama-35–50 
• · Iyahambelana namaqonga e-PCR aqhelekileyo ngexesha langempela

Ngokubonelela ngokuchongwa ngokukhawuleza kwee-molecular ze-pathogens kunye neempawu zokuxhathisa, uvavanyo lunokongeza kwimisebenzi eqhelekileyo ye-microbiology kwaye luxhase ukwenziwa kwezigqibo zonyango kwangethuba.

Ukusebenza kunye nxamnye ne-AMR

Ukumelana neentsholongwane akunakoyiswa ngamayeza okubulala iintsholongwane amatsha kuphela.

II-WHO, I-IDSA, I-ESCMIDkunyeI-CDCigxininisa rhoqo ukuba ulawulo olusebenzayo lwe-AMR lufuna ukuhlanganiswa kwezi zinto zilandelayo:

• · Ukuxilongwa ngokukhawuleza
• · Ulawulo lwe-antimicrobial
• · Ukuthintela nokulawula usulelo
• · Ukuhlolwa kwelebhu
• · Ukungenelela kwezonyango ngexesha elifanelekileyo

Njengoko iilabhoratri kwihlabathi liphela ziqhubeka nokuqinisa impendulo yazo ye-AMR, ukuxilongwa ngokukhawuleza kwe-multiplex molecular kunokudlala indima ebaluleke ngakumbi ekuxhaseni izigqibo zonyango ezisekelwe kubungqina kunye nokunceda ekunciphiseni ukusasazeka kwezifo ezinganyangekiyo.

Iireferensi

1. Abasebenzisana nabo ekuchaseni iintsholongwane.Umthwalo wehlabathi jikelele wokuxhathisa iintsholongwane kwiintsholongwane kwiibhaktheriya ngo-2019. ILancet.2022.

2. UMbutho wezeMpilo weHlabathi.Isicwangciso seHlabathi sokuSebenza malunga nokungaNyangeki kweeNtsholongwane.2015.

3. UMbutho wezeMpilo weHlabathi.Uluhlu lweentsholongwane ezibaluleke kakhulu kwi-WHO ngo-2024. 

4. UMbutho wezeMpilo weHlabathi.Iphulo Lokuxilonga Ukumelana Neentsholongwane.2024.

5. Umbutho weZifo eziSulelayo waseMelika (IDSA).Isikhokelo sika-2024 malunga noNyango lweeNtsholongwane eziNgenabungozi kwiGram-Negative. 

6. I-European Society of Clinical Microbiology and Infectious Diseases (ESCMID).Izikhokelo zoLawulo lweeNtsholongwane ezibangelwa yiBacilli yeGram-Negative enganyangekiyo ngamayeza amaninzi. 

7. Amaziko ase-US oLawulo nokuThintela izifo (i-CDC).Iingozi zokuxhathisa ii-antibiotic eMelika.