Croft Arthur C, D'Antoni Anthony V, Terzulli Stephanie L
Spine Research Institute of San Diego, Spring Valley, CA 91978, USA.
Med Sci Monit. 2007 Jun;13(6):RA103-18.
This nation--and in fact the world--is currently facing a crisis in the form of a growing antibacterial drug resistance. In the 60 or so years since the discovery of penicillin, physicians and pharmaceutical companies have been constantly challenged to stay a step ahead of the bacteria that constantly adapt to the drugs used to control them. These magic bullets were at one time expected to eliminate the concern over infectious disease and have been relied upon heavily. But their effectiveness has been steadily waning in recent years as, more and more, strains of bacteria emerge that are resistant to multiple drugs and, in some cases, have become nearly "panresistant." Nosocomial infections with these resistant strains were once confined to hospitals but new community-acquired infections are an ominous portent. Meanwhile, perhaps equally as distressing, many pharmaceutical companies are discontinuing efforts to develop new antimicrobial drugs for a variety of reasons and few new agents are currently in the pipeline. The selective pressure triggering these bacterial mutations are complex, but they can be shared by healthcare workers, hospitals, long-term care facilities, the agriculture industry, and even healthcare consumers themselves. In this paper, these topics are discussed, in turn, and the paper concludes with an apologia for change that can and should be equally shared by these stakeholders.
这个国家——实际上是全世界——目前正面临一场危机，其形式是抗菌药物耐药性不断增强。自青霉素发现后的大约60年里，医生和制药公司一直面临挑战，要比不断适应用于控制它们的药物的细菌领先一步。这些神奇的药物曾一度被期望消除对传染病的担忧，并被大量依赖。但近年来，它们的有效性一直在稳步下降，因为越来越多的细菌菌株出现了对多种药物耐药的情况，在某些情况下，甚至几乎“全耐药”。这些耐药菌株引起的医院感染曾经局限于医院，但新出现的社区获得性感染是一个不祥之兆。与此同时，也许同样令人苦恼的是，许多制药公司出于各种原因停止了开发新型抗菌药物的努力，目前几乎没有新的药物正在研发中。引发这些细菌突变的选择压力很复杂，但医护人员、医院、长期护理机构、农业行业，甚至医疗消费者自身都可能造成这种情况。本文依次讨论了这些话题，文章最后为变革进行了辩护，变革可以而且应该由这些利益相关者共同承担。
