Blakiston Matthew, Heffernan Helen, Roberts Sally, Freeman Joshua
Microbiology Registrar, Auckland DHB.
Scientist, Antibiotic Reference and Nosocomial Infections Laboratories, Institute of Environmental Science and Research Limited (ESR).
N Z Med J. 2017 Apr 28;130(1454):72-79.
Antimicrobial resistance (AMR) in general poses a threat to the sustainability of modern healthcare, but a particularly urgent and serious threat is posed by a specific group of antibiotic-resistant bacteria known as carbapenemase-producing Enterobacteriaceae (CPE). CPE are resistant to nearly all antibiotics and include common pathogens such as Escherichia coli and Klebsiella pneumoniae. In New Zealand, the incidence of CPE has increased from three isolates in 2012 to 45 in 2016. The current epidemiology of CPE in New Zealand has similarities with the extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-PE) epidemic in the early 2000s (just before ESBL-PE underwent a non-linear increase in incidence). Although to date in New Zealand, nearly all CPE have been imported from overseas, this situation appears to be changing, with evidence of secondary spread in both households and healthcare facilities over the last year. In this article, we argue that CPE should be regarded as the foremost AMR threat currently facing New Zealand, and highlight the need for a comprehensive national response plan, analogous to plans for other emerging transmissible infections, such as pandemic influenza and Ebola. We also make recommendations about the components of such a plan and advocate that CPE should be recognised as a key priority in New Zealand's national AMR strategy, due to be published in May 2017.
一般而言，抗菌药物耐药性（AMR）对现代医疗保健的可持续性构成威胁，但一类被称为产碳青霉烯酶肠杆菌科细菌（CPE）的特定耐药菌所构成的威胁尤为紧迫和严重。CPE对几乎所有抗生素均具有耐药性，包括常见病原体，如大肠杆菌和肺炎克雷伯菌。在新西兰，CPE的分离株数量已从2012年的3株增至2016年的45株。新西兰目前CPE的流行病学情况与21世纪初产超广谱β-内酰胺酶肠杆菌科细菌（ESBL-PE）的流行情况存在相似之处（就在ESBL-PE发病率呈非线性上升之前）。尽管到目前为止在新西兰，几乎所有CPE都是从海外输入的，但这种情况似乎正在改变，有证据表明去年在家庭和医疗保健机构中均出现了二次传播。在本文中，我们认为CPE应被视为新西兰目前面临的最主要的AMR威胁，并强调需要制定一项全面的国家应对计划，类似于针对其他新发可传播感染（如大流行性流感和埃博拉）的计划。我们还就该计划的组成部分提出了建议，并主张鉴于CPE应在将于2017年5月发布的新西兰国家AMR战略中被视为关键优先事项。
