Thaum Cov Tshuaj Tua Kab Mob Tsis Ua Haujlwm: Nkag Siab Txog Kev Hem Hem ntawm Carbapenemase thiab Lub Luag Haujlwm ntawm Kev Tshawb Pom Sai

Kev tiv thaiv kab mob (AMR) tau dhau los ua ib qho ntawm cov teeb meem kev noj qab haus huv thoob ntiaj teb uas tseem ceeb tshaj plaws ntawm peb lub sijhawm. Raws liXyoo 2024 Cov Npe Kab Mob Tseem Ceeb (BPPL)Lub Koom Haum Saib Xyuas Kev Noj Qab Haus Huv Ntiaj Teb tau tshaj tawm, ntau cov kab mob uas tiv taus carbapenem—xws liAcinetobacter baumannii, Kab mob Pseudomonas aeruginosa, thiab cov kab mob Enterobacteriaceae uas tiv taus carbapenem—tseem raug cais uaCov kab mob "Critical Priority", sawv cev rau qib kev hem thawj siab tshaj plaws rau kev noj qab haus huv pej xeem thoob ntiaj teb. Cov kab mob no cuam tshuam nrog kev kis kab mob hnyav thiab kev kho mob tsawg, qhia txog qhov xav tau kev kuaj mob, kev saib xyuas, thiab kev tswj hwm tshuaj tua kab mob sai.

Cov tshuaj tua kab mob tau ntev los ua peb txoj kev tiv thaiv zoo tshaj plaws tiv thaiv cov kab mob bacterial. Txawm li cas los xij, niaj hnub no, cov cuab yeej muaj zog no ntsib kev hem thawj loj hlob thiab txaus ntshai: kev tiv thaiv antimicrobial (AMR). Tab sis yog tias cov tshuaj tua kab mob uas koj noj tsis ua haujlwm lawm? Ib qho ntawm cov neeg ua txhaum loj tshaj plaws tom qab qhov kev ua tsis tiav no yog ib qho enzyme hu uacarbapenemase.

Cov Tshuaj Tua Kab Mob Ua Haujlwm Li Cas

Cov tshuaj tua kab mob ua haujlwm los ntawm kev tsom mus rau cov txheej txheem tshwj xeeb hauv cov kab mob, cuam tshuam lawv lub peev xwm kom muaj sia nyob thiab yug me nyuam:

1. Kev Tsim Phab Ntsa CellPiv txwv li, cov tshuaj Penicillins ua rau cov phab ntsa ntawm cov kab mob puas tsuaj, ua rau lawv tawg.
2. Kev Tsim Khoom ProteinCov tshuaj xws li tetracyclines thiab macrolides thaiv cov ribosomes ntawm cov kab mob, thiab ua rau cov protein synthesis qeeb.
3. Kev Rov Ua Dua DNA/RNAFluoroquinolones tiv thaiv cov enzymes bacterial uas xav tau rau DNA replication.
4. Kev Ncaj Ncees ntawm Cell MembraneCov Polymyxins ua rau cov kab mob puas tsuaj, ua rau cov cell tuag.
5. Txoj Kev MetabolicCov tshuaj sulfonamides thaiv cov txheej txheem tseem ceeb ntawm cov kab mob bacterial, xws li kev tsim cov folic acid.
   

   Cov txheej txheem no ua rau cov tshuaj tua kab mob muaj txiaj ntsig zoo heev. Txawm li cas los xij, qhov kev tiv thaiv tshuaj tua kab mob nce ntxiv ua rau lawv lub zog tsis muaj zog, ua rau qee qhov kab mob nyuaj rau kho.

    

   Carbapenemase: Ib Lub Tswv Yim Tiv Thaiv Kab Mob

   Carbapenemase yog ib qho enzyme uas cov kab mob me me tsim tawm los ua ib daim ntaub thaiv, ua rau cov tshuaj tua kab mob carbapenem tsis ua haujlwm zoo. Cov enzyme no rhuav tshem cov carbapenems ua ntej lawv nkag mus rau hauv cov hlwb kab mob, tiv thaiv lawv kom tsis txhob ua haujlwm tua kab mob. Yog li ntawd, cov kab mob me me uas muaj carbapenemase tuaj yeem muaj sia nyob thiab loj hlob txawm tias muaj cov tshuaj tua kab mob muaj zog.

   

   Kev Sib Tw ntawm Carbapenem Tsis kam

   Thaum cov kab mob carbapenemase tsim, xws liKlebsiella pneumoniaethiabAcinetobacter baumannii, feem ntau yog txuam nrog kev kis kab mob hauv tsev kho mob, qhov kev hem thawj ntawm kev tiv thaiv carbapenem nthuav dav tshaj li tsev neeg Enterobacteriaceae xwb. Cov kab mob uas tiv taus carbapenem kuj tseem tuaj yeem suav nrog lwm cov kab mob phem, xws liKab mob Pseudomonas aeruginosathiabStenotrophomonas maltophiliaCov kab mob no muaj peev xwm tsim cov enzymes carbapenemase, uas ua rau lawv tiv taus ntau yam tshuaj tua kab mob, ua rau cov kev kho mob nyuaj.

   Hauv cov chaw kho mob, cov kab mob uas tsis kam siv carbapenem tuaj yeem ua rau muaj mob ntev, nqi kho mob siab dua, thiab txawm tias tuag taus. 

   Cov Lus Qhia rau Kev Ntsuas Carbapenemase

   Txhawm rau daws qhov teeb meem ntawm kev tiv thaiv kab mob antimicrobial uas tab tom loj hlob tuaj, cov koom haum kev noj qab haus huv, suav nrog WHO, hais txog qhov tseem ceeb ntawm kev kuaj mob carbapenemase tsis tu ncua thiab tsis tu ncua, tshwj xeeb tshaj yog nyob rau hauv cov chaw muaj kev pheej hmoo siab. Cov lus qhia no yog qhov tseem ceeb rau kev tswj hwm kev tiv thaiv thiab tiv thaiv kev noj qab haus huv pej xeem.

   Kev Kuaj Mob Tsis Tu Ncua Hauv Cov Cheeb Tsam Muaj Kev Pheej Hmoo SiabYuav tsum tau kuaj carbapenemase tsis tu ncua hauv cov chaw tseem ceeb xws li chav kho mob hnyav (ICUs), chav kho mob ceev, thiab chav kho mob qog nqaij hlav, qhov chaw uas cov neeg mob muaj feem yuav kis tau cov kab mob uas tiv taus tau.

   Kev Tshawb Pom Thaum Ntxov thiab Kev Kho MobKev paub txog carbapenemase thaum ntxov ua rau cov kws kho mob hloov kho cov phiaj xwm kho mob sai, txhim kho cov txiaj ntsig ntawm tus neeg mob thiab txo qhov kev pheej hmoo ntawm kev kis kab mob ntev.

   Cov Txheej Txheem Tswj Kev Kis Kab MobThaum kuaj pom carbapenemase, cov kev tswj hwm kev kis kab mob nruj heev—xws li kev cais tus neeg mob thiab kev ceev faj ntawm cov neeg ua haujlwm—yog qhov tsim nyog los tiv thaiv kev kis tus kab mob uas tiv taus.

   Kev Soj Ntsuam thiab Kev Saib Xyuas tas mus liKev soj ntsuam tas mus li ntawm carbapenemase hauv tsev kho mob yog qhov tseem ceeb rau kev taug qab cov qauv kev tiv thaiv, txheeb xyuas cov kev hem thawj tshiab, thiab npaj cov kev ua tiv thaiv.

   Kev Kuaj Mob Carbapenemase: Qhov Tseem Ceeb Rau Kev Kho Mob Uas Tau Targeted

   Kev kuaj pom carbapenemase kom raug yog qhov tseem ceeb rau kev xaiv txoj kev kho mob kom raug thiab tiv thaiv kev kis tus kab mob uas tiv taus. Cov txheej txheem kuaj mob suav nrog:

   • Kev Ntsuas PhenotypicCov txheej txheem xws li disk diffusion (yooj yim thiab pheej yig, tab sis tsis tshua muaj kev cuam tshuam), qhov kev xeem Hodge hloov kho (tshwj xeeb tab sis nyuaj), thiab qhov kev xeem Carba NP (ceev tab sis zoo tshaj plaws hauv qhov chaw tswj tau).
   • Kev Ntsuas GeneticCov txheej txheem PCR muab kev kuaj pom tseeb ntawm cov noob carbapenemase, muab cov kev nkag siab ntxaws ntxaws txog cov qauv kev tiv thaiv.
   • Kev Ntsuas Kub Colloidal: Ib txoj kev sim tshiab, sai, thiab raug heev.

   Taw Qhia Peb Ob Lub Khoom Siv Tshawb Nrhiav Carbapenemase Qib Siab

   Txhawm rau daws qhov teeb meem ntawm AMR uas tab tom loj hlob zuj zus, peb lub tuam txhab muaj 3 lub cuab yeej nrhiav carbapenemase tshiab - txhua lub tsim los ua kom tau raws li cov kev xav tau sib txawv hauv kev kho mob. Cov cuab yeej no ua rau cov kws kho mob tuaj yeem txheeb xyuas cov kab mob uas tiv taus tau sai thiab raug, kom ntseeg tau tias muaj kev kho mob raws sijhawm thiab cov txiaj ntsig zoo dua rau cov neeg mob.

   1. Cov Khoom Siv Tshawb Nrhiav Carbapenemase

   Siv cov thev naus laus zis kub colloidal rau kev kuaj pom carbapenemase sai thiab txhim khu kev qha. Nws yog tsim los rau kev siv hauv tsev kho mob, chaw kho mob, thiab txawm tias nyob hauv tsev, ua kom yooj yim rau cov txheej txheem kuaj mob nrog qhov tseeb siab.

   

   Cov Nta Tseem Ceeb:

   • Kev Tshawb Fawb Txog Kev Ua HaujlwmTxheeb xyuas cov noob tiv thaiv NDM, KPC, OXA-48, IMP, thiab VIM hauv ib qho kev sim.
   • Cov Txiaj Ntsig SaiXa cov txiaj ntsig hauv qab 15 feeb, piv rau 1-2 hnub rau cov kev kuaj ib txwm muaj.
   • Yooj Yim Siv: Tsis tas yuav siv cov khoom siv nyuaj lossis kev cob qhia tshwj xeeb, ua rau nws zoo tagnrho rau ntau qhov chaw.
   • Kev Siv Nyiaj Tau ZooMuab tsib qhov kev xeem ua ke ua ib qho, txuag tau ob qho tib si lub sijhawm thiab cov peev txheej.
   • Kev Raug Siab: Muaj 95% kev rhiab heev uas tsis muaj qhov tsis tseeb los ntawm cov kab mob zoo liKlebsiella pneumoniaelos yogKab mob Pseudomonas aeruginosa.
   • Daim Ntawv Thov Dav Dav: Haum rau cov chaw muaj kev txwv thiab kev tswj kab mob pem hauv ntej.
   1. Cov Khoom Siv Tshawb Nrhiav Gene Uas Tiv Thaiv Carbapenem (Fluorescence PCR)

   LubCov Khoom Siv Tshawb Nrhiav Gene Carbapenem Tiv Thaivyog tsim los rau kev tshuaj xyuas tob dua, kev tshuaj xyuas caj ces ntawm kev tiv thaiv carbapenem. Cov khoom siv no zoo tagnrho rau kev saib xyuas tag nrho hauv cov chaw kuaj mob, muab kev kuaj pom tseeb ntawm ntau cov noob tiv thaiv carbapenem.

   Cov Nta Tseem Ceeb:

   • Kev kuaj qauv yooj ywm: Tuaj yeem ntes tau ncaj qha los ntawm cov kab mob hauv cov kab mob, cov hnoos qeev, lossis cov ntaub so quav - tsis tas yuav kuaj kab mob.
   • Txo Tus Nqi: Nrhiav tau rau lub noob tiv thaiv tseem ceeb hauv ib qho kev sim, tshem tawm qhov xav tau kev sim ntau dhau thiab txuag cov peev txheej.
   • Kev rhiab heev thiab kev tshwj xeeb: Tshawb pom tsawg li 1000 CFU/mL yam tsis muaj kev cuam tshuam nrog lwm cov kab mob ua pa lossis cov noob tiv thaiv xws li CTX, mecA, SME, SHV, thiab TEM.
   • Qauv rau Cov Lus Teb Protocol:
   • Kev Sib Tw Dav DavUa haujlwm zoo nrog cov cuab yeej PCR tseem ceeb kom yooj yim koom ua ke rau hauv cov haujlwm hauv chaw kuaj mob uas twb muaj lawm.
   1. Klebsiella Pneumoniae, Acinetobacter Baumannii thiab Pseudomonas Aeruginosa thiab Cov noob caj noob ces tiv taus tshuaj (KPC, NDM, OXA48 thiab IMP) Multiplex Detection Kit (Fluorescence PCR)

   Cov khoom siv no muab kev txheeb xyuas cov kab mob thiab lawv cov txheej txheem tiv thaiv kab mob ua ke rau hauv ib qho feature rau kev nkag siab yooj yim.

   • Kev Tshawb Fawb Txog Kev Ua Haujlwm: Multiplex PCR Txheeb xyuas 3 tus kab mob tseem ceeb—Klebsiella pneumoniae (Kp), Acinetobacter baumannii (Aba), thiab Pseudomonas aeruginosa (Pa)—thiab ntes plaub lub noob carbapenemase tseem ceeb—KPC, NDM, OXA48, thiab IMP hauv ib qho kev kuaj, ua kom cov txheej txheem kuaj mob yooj yim dua.
   • Kev rhiab heev:Muaj peev xwm nrhiav tau cov kab mob DNA ntawm qhov concentration qis li 1000 CFU / mL, ua kom ntseeg tau tias muaj kev txheeb xyuas txawm tias nyob rau hauv cov qauv kuaj kab mob tsawg.
   • Txhawb Kev Txiav Txim Siab Hauv Kev Kho Mob:Pab txhawb kev tswj hwm kev kho mob raws sijhawm thiab tsim nyog los ntawm kev txheeb xyuas cov kab mob uas tiv taus thaum ntxov, pab xaiv cov kev kho mob tua kab mob zoo.
   • Kev Sib Tw Dav DavUa haujlwm zoo nrog cov cuab yeej PCR tseem ceeb kom yooj yim koom ua ke rau hauv cov haujlwm hauv chaw kuaj mob uas twb muaj lawm.

   Cov khoom siv kuaj mob 3 yam no muab cov cuab yeej rau cov kws kho mob uas lawv xav tau los daws AMR ntawm ntau qib sib txawv—txij li kev kuaj mob sai sai mus txog kev txheeb xyuas cov noob caj noob ces kom ntxaws—kom ntseeg tau tias muaj kev cuam tshuam raws sijhawm thiab txo qhov kev kis tus kab mob uas tiv taus kab mob.

   Kev sib ntaus sib tuaAMRnrog Kev Ntsuas Tseeb

   Ntawm Macro & Micro-Test, peb muab cov khoom siv kuaj mob tshiab los pab cov kws kho mob kom nkag siab sai thiab ntseeg tau, ua rau hloov kho kev kho mob sai thiab tswj kev kis kab mob tau zoo.

   Koom nrog kev tawm tsam tiv thaiv kev tiv thaiv kab mob - vim tias txhua txoj sia uas cawm tau suav nrog.

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