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这12种细菌种族已成人类健康大威胁!
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发布时间:2017-03-02 浏览数:828

这12种细菌种族已成人类健康大威胁!


世卫组织前天发表了首份抗生素耐药重点病原体清单——这是对人类健康构成最大威胁的12种细菌种族目录。

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制定该清单的用意在于指导和促进新型抗生素的研究与开发,这是世卫组织努力解决日益严重的全球抗微生物药物耐药性的部分内容。

 该清单特别强调了对多种抗生素存有耐药的革兰氏阴性细菌的威胁性问题。这些细菌具有寻找新方法抵抗治疗的内在能力,并且还可以传递使其它细菌产生耐药的遗传物质。

 

blob.pngMarie-Paule Kieny博士

世卫组织卫生系统和

创新助理总干事

这份清单是用来确保研发工作面向公共卫生紧急需求的新工具。抗生素耐药性问题不断加重,我们的治疗选用办法正在快速耗尽。如果仅仅依靠市场力量来解决问题,我们最迫切需要的新型抗生素将不会得到及时开发。

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 世卫组织根据对新型抗生素的迫切需求程度将清单分为三个类别:极为重要、十分重要和中等重要。

 最为重要的一组包括耐多药细菌,这些细菌在医院、养老院以及在需要用通气机和血液导管等装置进行护理的患者中带来了特定威胁。它们包括不动杆菌属、假单胞菌属和各种肠杆菌科(包括克雷伯氏菌属、大肠杆菌、沙雷氏菌属和变形杆菌属)。这些细菌可引起严重且常常致命的感染,例如血流感染和肺炎。

 这些细菌已经对大量抗生素产生了耐药性,包括碳青霉烯类和第三代头孢菌素类药物——用于治疗耐多药细菌的最佳可用抗生素。

 清单中的第二和第三个层级为十分重要和中等重要类别,其中含有其他一些日益出现耐药并引起更常见疾病的细菌,例如淋病和由沙门氏菌引起的食物中毒。

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  二十国集团卫生专家将于本周在柏林会面。

 

我们的卫生系统需要有效抗生素。为了更加健康的未来,我们现在必须采取联合行动。因此,我们将讨论并提请二十国集团关注为控制抗微生物药物耐药性做出的努力。世卫组织制定的首份全球重点病原体清单是确保和指导新抗生素相关研究和开发的重要新工具。

 

——Hermann Gröhe先生

德国联邦卫生部长

 

该清单旨在促进政府制定政策,激励公共资助机构和对发现新型抗生素进行投资的私营部门开展基础科学和先进研发工作。它将为新的研发举措提供指导,如致力于非营利性新型抗生素开发的世卫组织/被忽视疾病药物行动全球抗生素研发伙伴关系。

结核病对传统治疗方法的耐药性近年来一直呈增长之势。之所以没有将其列入清单,就是因为它是其它专门规划的工作目标。也没有将甲型和乙型链球菌和衣原体等其它细菌纳入其中,这类细菌对现有治疗办法的耐药程度较低,且目前不会带来公共卫生重大威胁。

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 该清单是利用经过一组国际专家审查的多标准决策分析技术,与德国蒂宾根大学传染病处合作开发完成的。病原体的选择列表标准为:

 ·         所引起感染的致命程度如何;

·         是否需要长期住院治疗;

·         当社区成员接触现有抗生素时出现耐药的频次;

·         在动物之间、从动物到人以及人与人传播的容易程度;

·         是否可以预防(例如通过讲究卫生和实施疫苗接种);

·         还剩多少治疗选用方案;以及

·         是否已有新的抗生素治疗方法处于研发过程中。

 

针对这种病原体优先列表获得的新型抗生素将有助于减少世界各地因耐药感染造成的死亡。继续等待将会带来更多公共卫生问题,并对病人治疗产生很大影响。

 

——Evelina Tacconelli教授

蒂宾根大学传染病处处长以及

清单制定主要贡献者

 

虽然更多研发努力至关重要,但仅仅靠此并不能解决问题。为了解决耐药性问题,还必须更好地预防感染并在人间和动物中间适当使用现有抗生素,以及合理使用将来开发出来的任何新型抗生素。

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世卫组织新型抗生素研发重点病原体清单

1类重点:极为重要

1.   碳青霉烯类药物耐药鲍曼不动杆菌

2.   碳青霉烯类药物耐药绿脓杆菌

3.   碳青霉烯类药物耐药、产超广谱β-内酰胺酶(ESBL)肠杆菌科

2类重点:十分重要

1.   万古霉素耐药屎肠球菌

2.   甲氧西林耐药、万古霉素中介和耐药金黄色葡萄球菌

3.   克拉霉素耐药幽门螺旋杆菌

4.   氟喹诺酮类药物耐药弯曲菌属

5.   氟喹诺酮类药物耐药沙门氏菌

6.   头孢菌素耐药、氟喹诺酮类药物耐药淋病奈瑟菌

3类重点:中等重要

1.   青霉素不敏感肺炎链球菌

2.   氨苄西林耐药流感嗜血杆菌

3.   氟喹诺酮类药物耐药志贺氏菌属

    

WHO publishes list of bacteria for which new antibiotics are urgently needed

 WHO the day before yesterday published its first ever list of antibiotic-resistant "priority pathogens" – a catalogue of 12 families of bacteria that pose the greatest threat to human health.

 The list was drawn up in a bid to guide and promote research and development (R&D) of new antibiotics, as part of WHO’s efforts to address growing global resistance to antimicrobial medicines.

 The list highlights in particular the threat of gram-negative bacteria that are resistant to multiple antibiotics. These bacteria have built-in abilities to find new ways to resist treatment and can pass along genetic material that allows other bacteria to become drug-resistant as well.

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  "This list is a new tool to ensure R&D responds to urgent public health needs," says Dr Marie-Paule Kieny, WHO's Assistant Director-General for Health Systems and Innovation. "Antibiotic resistance is growing, and we are fast running out of treatment options. If we leave it to market forces alone, the new antibiotics we most urgently need are not going to be developed in time."

 The WHO list is divided into three categories according to the urgency of need for new antibiotics: critical, high and medium priority.

 The most critical group of all includes multidrug resistant bacteria that pose a particular threat in hospitals, nursing homes, and among patients whose care requires devices such as ventilators and blood catheters. They include Acinetobacter, Pseudomonas and various Enterobacteriaceae (including Klebsiella,E. coli, Serratia, and Proteus). They can cause severe and often deadly infections such as bloodstream infections and pneumonia.

 These bacteria have become resistant to a large number of antibiotics, including carbapenems and third generation cephalosporins – the best available antibiotics for treating multi-drug resistant bacteria.

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  The second and third tiers in the list – the high and medium priority categories – contain other increasingly drug-resistant bacteria that cause more common diseases such as gonorrhoea and food poisoning caused by salmonella.

 G20 health experts will meet this week in Berlin. Mr Hermann Gröhe, Federal Minister of Health, Germany says "We need effective antibiotics for our health systems. We have to take joint action today for a healthier tomorrow. Therefore, we will discuss and bring the attention of the G20 to the fight against antimicrobial resistance. WHO’s first global priority pathogen list is an important new tool to secure and guide research and development related to new antibiotics."

 The list is intended to spur governments to put in place policies that incentivize basic science and advanced R&D by both publicly funded agencies and the private sector investing in new antibiotic discovery. It will provide guidance to new R&D initiatives such as the WHO/Drugs for Neglected Diseases initiative (DNDi) Global Antibiotic R&D Partnership that is engaging in not-for-profit development of new antibiotics.

 Tuberculosis – whose resistance to traditional treatment has been growing in recent years – was not included in the list because it is targeted by other, dedicated programmes. Other bacteria that were not included, such as streptococcus A and B and chlamydia, have low levels of resistance to existing treatments and do not currently pose a significant public health threat.

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  The list was developed in collaboration with the Division of Infectious Diseases at the University of Tübingen, Germany, using a multi-criteria decision analysis technique vetted by a group of international experts. The criteria for selecting pathogens on the list were: how deadly the infections they cause are; whether their treatment requires long hospital stays; how frequently they are resistant to existing antibiotics when people in communities catch them; how easily they spread between animals, from animals to humans, and from person to person; whether they can be prevented (e.g. through good hygiene and vaccination); how many treatment options remain; and whether new antibiotics to treat them are already in the R&D pipeline.

 "New antibiotics targeting this priority list of pathogens will help to reduce deaths due to resistant infections around the world," says Prof Evelina Tacconelli, Head of the Division of Infectious Diseases at the University of Tübingen and a major contributor to the development of the list. "Waiting any longer will cause further public health problems and dramatically impact on patient care."

 While more R&D is vital, alone, it cannot solve the problem. To address resistance, there must also be better prevention of infections and appropriate use of existing antibiotics in humans and animals, as well as rational use of any new antibiotics that are developed in future.

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 WHO priority pathogens list for R&D of new antibiotics

Priority 1: CRITICAL

1.   Acinetobacter baumannii, carbapenem-resistant

2.   Pseudomonas aeruginosa, carbapenem-resistant

3.   Enterobacteriaceae, carbapenem-resistant, ESBL-producing

Priority 2: HIGH

1.   Enterococcus faecium, vancomycin-resistant

2.   Staphylococcus aureus, methicillin-resistant, vancomycin-intermediate and resistant

3.   Helicobacter pylori, clarithromycin-resistant

4.   Campylobacter spp., fluoroquinolone-resistant

5.   Salmonellae, fluoroquinolone-resistant

6.   Neisseria gonorrhoeae, cephalosporin-resistant, fluoroquinolone-resistant

Priority 3: MEDIUM

1.   Streptococcus pneumoniae, penicillin-non-susceptible

2.   Haemophilus influenzae, ampicillin-resistant

3.   Shigella spp., fluoroquinolone-resistant


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