Kev tiv thaiv kab mob (AMR) tau dhau los ua ib qho kev hem thawj loj tshaj plaws rau kev noj qab haus huv pej xeem thoob ntiaj teb.

Ib txoj kev tshawb fawb tseem ceeb tau luam tawm hauvPhau Ntawv Lancetkwv yees tiasMuaj 1.27 lab tus neeg tuag hauv xyoo 2019 vim yog kev tiv thaiv kab mob tua kab mob (AMR), thaum yuav luag5 lab tus neeg tuag tau cuam tshuam nrog cov kab mob AMR. Zoo kawg li,73% ntawm cov neeg tuag uas muaj AMR yog los ntawm rau tus kab mob bacterial pathogens xwb, hais txog qhov xav tau kev saib xyuas zoo, kev tiv thaiv kev kis kab mob, kev saib xyuas cov tshuaj tua kab mob, thiab kev kuaj mob sai.

Ntawm cov kab mob no, peb hom kab mob Gram-negative tsim nyog tau txais kev saib xyuas tshwj xeeb:

• · Klebsiella pneumoniae(KPN)
• · Acinetobacter baumannii(Aba)
• · Kab mob Pseudomonas aeruginosa(PA)

Cov kab mob no tiv taus cov carbapenems ntau zuj zus - lub hauv paus tseem ceeb ntawm kev kho mob rau ntau yam kab mob Gram-negative hnyav - thiab raug lees paub thoob ntiaj teb tias yog cov kab mob tseem ceeb.

LEEJ TWG Txheeb Xyuas Cov Kab Mob No Ua Qhov Tseem Ceeblos yog Qhov Tseem Ceeb Tshaj Plaws

LubDaim Ntawv Teev Cov Kab Mob Tseem Ceeb ntawm WHO (BPPL) 2024nrhiav pom cov kab mob uas tiv taus tshuaj tua kab mob uas xav tau kev nqis peev sai rau kev kuaj mob tshiab, kev kho mob, tshuaj tiv thaiv kab mob, thiab cov tswv yim tiv thaiv kev kis kab mob.

Ntawm covTseem ceeb heev/SiabQhov Tseem Ceebcov kab mob pathogens yog:

• · Tiv taus CarbapenemAcinetobacter baumannii(KAB NTSEG)
• · Tiv taus CarbapenemKab mob Pseudomonas aeruginosa(CRPA)
• · Cov kab mob Enterobacterales (CRE) uas tiv taus Carbapenem, suav nrogKlebsiella pneumoniae(CRKP)

Lub koom haum WHO tseem hais ntxiv tias kev daws cov kab mob no xav tau kev sib koom ua kekev kuaj mob sai, kev saib xyuas, kev tswj hwm tshuaj tua kab mob (AMS), thiab kev tiv thaiv thiab tswj kev kis kab mob (IPC)es tsis txhob cia siab rau kev tsim cov tshuaj tua kab mob tshiab xwb.

Cov Lus Qhia Thoob Ntiaj Teb Qhia Txog Qhov Tseem Ceeb ntawm Kev Kuaj Mob Sai

Kev tawm tsam AMR xav tau ntau tshaj li cov tshuaj tua kab mob zoo xwb—nws nyob ntawm seb yuav kuaj mob raws sijhawm thiab raug li cas.

LubWHO Txoj Kev Npaj Ua Haujlwm Thoob Ntiaj Teb rau Kev Tiv Thaiv Kab Mobtxheeb xyuas kev txhawb nqa lub peev xwm hauv chaw kuaj mob thiab nthuav kev nkag mus rau kev kuaj mob zoo ua qhov tseem ceeb rau kev txhim kho kev saib xyuas thiab kev siv tshuaj tua kab mob kom zoo dua.

Los ntawm txoj kev npaj no,Kev Tshawb Fawb Txog Kev Tiv Thaiv Kab Mob ntawm WHO (2024)qhia txog kev kuaj mob sai sai ua ib qho cuab yeej tseem ceeb rau:

• · Txhawb kev tswj hwm tshuaj tua kab mob (AMS)
• · Qhia kev kho mob tua kab mob raws sijhawm thiab tsim nyog
• · Pab kom muaj kev tiv thaiv thiab tswj kev kis kab mob (IPC)
• · Txhawb kom muaj kev soj ntsuam AMR ntxiv zog
• · Txhim kho kev kuaj pom thiab teb rau qhov muaj tus kab mob sib kis
• 

Ib yam li ntawd, covLub Koom Haum Kab Mob Sib Kis ntawm Asmeskas (IDSA)pom zoo kom kuaj mob sai sai, yog tias muaj, los txheeb xyuas cov kab mob bacterial pathogens thiab cov txheej txheem tiv thaiv ua ntej, uas tso cai rau cov kws kho mob kom ua tau zoo tshaj plaws kev kho mob antimicrobial thiab txo qhov kev raug tshuaj tua kab mob dav dav tsis tsim nyog.

LubLub Koom Haum European ntawm Kev Kho Mob Microbiology thiab Cov Kab Mob Sib Kis (ESCMID)kuj tseem pom zoo kom paub sai sai txog cov kab mob Gram-negative uas tsim cov carbapenemase kom yooj yim rau kev siv cov kev ntsuas tswj kev kis kab mob thaum ntxov thiab kev kho mob antimicrobial kom tsim nyog.

Ua ke, cov lus pom zoo thoob ntiaj teb no txhawb nqa ib qho lus sib xws:Kev kuaj mob sai sai molecular tau dhau los ua ib feem tseem ceeb ntawm kev tswj hwm AMR niaj hnub no.

Nkag Siab Txog KPN, Aba thiab PA

Kab mob Klebsiella pneumoniae (KPN)

K. mob ntswsyog ib qho ua rau mob ntsws ntsig txog kev kho mob, kev kis kab mob hauv cov ntshav, kev kis kab mob ntawm txoj hlab zis, thiab sepsis.

Tsis kam rau CarbapenemK. mob ntswsfeem ntau nqa cov noob carbapenemase suav nrog: KPC, NDM, OXA-48-zoo li thiab IMP.

Cov kab mob hypervirulent yuav ua ke nrog kev ua kom muaj zog ntxiv nrog kev tiv taus ntau yam tshuaj, tsim kom muaj kev cov nyom loj heev rau kev kho mob.

Acinetobacter baumannii (Aba)

A. baumanniimuaj zog heev thiab muaj peev xwm nyob tau rau ntawm ib puag ncig ntev.

Nws muaj feem cuam tshuam nrog:

• · Kev kis tus kab mob hauv ICU
• · Mob ntsws uas cuam tshuam nrog lub tshuab ua pa (VAP)
• · Kev kis kab mob hauv cov ntshav
• · Kev kis kab mob cuam tshuam nrog cov khoom siv

Nws lub peev xwm zoo kawg nkaus los nrhiav cov yam ntxwv tiv taus tau ua rau carbapenem-resistantA. baumanniiib qho ntawm cov kab mob hauv tsev kho mob uas nyuaj kho tshaj plaws.

Kab mob Pseudomonas aeruginosa (PA)

P. aeruginosayog ib yam kab mob uas feem ntau kis rau cov neeg mob uas muaj mob hnyav thiab cov neeg uas lub cev tiv thaiv kab mob tsis zoo.

Kev tiv thaiv kab mob sab hauv, kev hloov pauv sai ntawm cov noob caj noob ces, thiab kev tsim cov biofilm ua rau muaj kev kis kab mob tas mus li thiab ua rau muaj kev tiv thaiv carbapenem ntau ntxiv thoob ntiaj teb.

Kev Sib Kis Hauv Chaw Kho Mob

Cov kab mob uas tiv taus ntau yam tshuaj no feem ntau kis tau los ntawm:

• Cov khoom siv kho mob thiab cov chaw ib puag ncig uas muaj kuab paug
• · Cov tes ntawm cov neeg ua haujlwm kho mob
• · Cov neeg mob uas muaj kab mob los yog muaj kab mob hauv plab hnyuv
• · Cov kua qaub ncaug ua pa
• · Cov khoom siv nkag mus rau hauv lub cev xws li cov tshuab ua pa thiab cov catheter

Raws li qhovTebchaws Meskas Lub Chaw Tswj thiab Tiv Thaiv Kab Mob (CDC), kev kuaj pom thaum ntxov hauv chaw kuaj mob ua ke nrog kev saib xyuas cov tshuaj tua kab mob thiab kev tiv thaiv kev kis kab mob hnyav yog qhov tseem ceeb rau kev txo qis kev sib kis kab mob uas cuam tshuam nrog kev kho mob ntawm cov kab mob uas tiv taus ntau yam tshuaj.

Kev Kho Mob Cov Teeb Meem

Cov kev xaiv kho mob tseem pheej tsawg zuj zus.

Cov teeb meem tam sim no suav nrog:

• · Ua kom cov tshuaj carbapenem tsis kam
• · Muaj tsawg cov tshuaj tua kab mob tshiab
• Kev lom nrog polymyxins
• · Kev tiv thaiv tshiab rau cov neeg sawv cev tshiab

Yog li ntawd, cov lus qhia thoob ntiaj teb ib txwm pom zoo kom tau txais cov pov thawj microbiological raws sijhawm los txhawb kev kho mob antimicrobial thaum twg ua tau.

Vim Li Cas Kev Tshawb Fawb Txog Molecular Sai Thiaj Tseem Ceeb

Kev kuaj kab mob thiab kev tiv thaiv kab mob feem ntau yuav tsum tau kuaj kab mob48–72 teevua ntej cov txiaj ntsig ua tau los muaj.

Kev kuaj mob sai sai ntawm cov molecular tuaj yeem ua rau lub sijhawm no luv dua los ntawm kev txheeb xyuas cov kab mob thiab cov noob tiv thaiv tseem ceeb hauv kev kho mob tib lub sijhawm, ua rau ua ntej:

• · Kev kho mob tua kab mob kom zoo
• · Kev tiv thaiv kab mob
• · Cov kev txiav txim siab txog kev saib xyuas cov kab mob tua kab mob
• · Kev saib xyuas cov kab mob uas tiv taus

Ib qho kev daws teeb meem Multiplex PCR rau kev txiav txim siab sai dua hauv kev kho mob

Txhawm rau txhawb kev txheeb xyuas sai ntawm cov kab mob Gram-negative tseem ceeb thiab cov txheej txheem tiv thaiv carbapenem,Macro & Micro-Test's KPN, Aba, PA & Cov Tshuaj Tiv Thaiv Genes Multiplex Detection Kittib lub sijhawm ntes tau:

Cov kab mob uas raug tsom: Klebsiella pneumoniae, Acinetobacter baumannii, Kab mob Pseudomonas aeruginosa 

Cov noob caj noob ces Carbapenemase: KPC, NDM, OXA-48, IMP

Cov Nta Tseem Ceeb

• Kev kuaj pom ncaj qha los ntawm cov qauv hnoos qeev
• · Tsis tas yuav tsum tau ua kom muaj kev txhim kho kab lis kev cai ntev
• · Kev rhiab heev ntawm kev tshuaj xyuas:LoD 1000 CFU/mL 
• · Cov txiaj ntsig muaj nyob rau hauv35–50 feeb 
• · Sib xws nrog cov platform PCR tiag tiag

Los ntawm kev muab kev txheeb xyuas sai sai ntawm cov kab mob thiab cov cim tiv thaiv, qhov kev ntsuam xyuas tuaj yeem ua tiav cov txheej txheem ua haujlwm microbiology ib txwm muaj thiab txhawb kev txiav txim siab kho mob ua ntej.

Ua Haujlwm Ua Ke Tawm Tsam AMR

Kev tiv thaiv kab mob tsis tuaj yeem kov yeej los ntawm kev siv cov tshuaj tua kab mob tshiab xwb.

LubWHO, IDSA, ESCMID, thiabCDCtsis tu ncua hais tias kev tswj hwm AMR zoo yuav tsum muaj kev koom ua ke ntawm:

• · Kev kuaj mob sai
• · Kev tiv thaiv kab mob
• · Kev tiv thaiv thiab tswj kab mob
• · Kev soj ntsuam hauv chaw kuaj mob
• · Kev kho mob raws sijhawm

Raws li cov chaw soj nstuam thoob ntiaj teb txuas ntxiv txhawb lawv cov lus teb AMR, kev kuaj mob molecular sai sai tuaj yeem ua lub luag haujlwm tseem ceeb hauv kev txhawb nqa kev txiav txim siab kho mob raws li pov thawj thiab pab txo qhov kev sib kis ntawm cov kab mob tiv taus.

Cov ntaub ntawv siv los ua piv txwv

1. Cov Neeg Koom Tes Tiv Thaiv Kab Mob.Lub nra hnyav thoob ntiaj teb ntawm kev tiv thaiv kab mob bacterial hauv xyoo 2019. Phau ntawv Lancet.2022.

2. Lub Koom Haum Kev Noj Qab Haus Huv Ntiaj Teb.Txoj Kev Npaj Ua Haujlwm Thoob Ntiaj Teb txog Kev Tiv Thaiv Kab Mob.Xyoo 2015.

3. Lub Koom Haum Kev Noj Qab Haus Huv Ntiaj Teb.Daim Ntawv Teev Cov Kab Mob Tseem Ceeb ntawm WHO xyoo 2024. 

4. Lub Koom Haum Kev Noj Qab Haus Huv Ntiaj Teb.Kev Pib Tshawb Fawb Txog Kev Tiv Thaiv Kab Mob.2024.

5. Lub Koom Haum Kab Mob Sib Kis ntawm Asmeskas (IDSA).Xyoo 2024 Cov Lus Qhia Txog Kev Kho Mob Cov Kab Mob Gram-Negative Uas Tiv Thaiv Tau Tshuaj Antimicrobial. 

6. Lub Koom Haum European Society of Clinical Microbiology and Infectious Diseases (ESCMID).Cov Lus Qhia rau Kev Tswj Xyuas Cov Kab Mob Uas Ua Los Ntawm Cov Kab Mob Gram-Negative Bacilli Uas Tiv Thaiv Tau Ntau Yam Tshuaj. 

7. Lub Chaw Tswj thiab Tiv Thaiv Kab Mob hauv Tebchaws Meskas (CDC).Kev hem thawj ntawm kev tiv thaiv tshuaj tua kab mob hauv Tebchaws Meskas.