Ouedraogo A S, Jean Pierre H, Bañuls A L, Ouédraogo R, Godreuil S
Service de bactériologie-virologie, CHU de Souro Sanou, Bobo Dioulasso, Burkina Faso.
Laboratoire de bactériologie-virologie, CHU de Montpellier, 34295 Montpellier cedex 5, France.
Med Sante Trop. 2017 Jun 1;27(2):147-154. doi: 10.1684/mst.2017.0678.
The emergence and spread of antibiotic resistance present a major public health issue in both developed (DC) and less developed countries (LDC). Worldwide, its main cause is the uncontrolled and unjustified use of antibiotics. In countries with limited resources, such as West African nations, other features, more specifically socioeconomic and behavioral factors, contribute to exacerbate this problem. The objective of this review is to give an update of the common and specific factors involved in the amplification of antibiotic resistance phenomena in LCD, particularly in West African countries. In particular, some frequent societal behaviors (such as self-medication), inadequate healthcare infrastructure (insufficiently trained prescribers and inadequate diagnostic tools), and an uncontrolled drug sector (antibiotics sold over-the-counter, improperly stored, counterfeit, and/or expired) all strongly promote the emergence of antibiotic resistance. This risk is particularly worrisome for enterobacteriaceae producing extended spectrum beta-lactamases (10 to 100 % of colonizations and 30 to 50 % of infections). A similar trend has been observed for carbapenem resistance in enterobacteriaceae with rates ranging from 10 to 30 % and for methicillin resistance in Staphylococcus aureus, which now exceeds 30 %. These troubling observations call for effective health policies in these regions. These intervention strategies must be integrated and simultaneously target policy makers, prescribers, and users.
抗生素耐药性的出现和传播在发达国家（DC）和欠发达国家（LDC）都是一个重大的公共卫生问题。在全球范围内，其主要原因是抗生素的不受控制和不合理使用。在资源有限的国家，如西非国家，其他因素，更具体地说是社会经济和行为因素，加剧了这一问题。本综述的目的是更新在欠发达国家，特别是在西非国家中，参与抗生素耐药现象放大的常见和特定因素。特别是，一些常见的社会行为（如自我用药）、不完善的医疗基础设施（处方者培训不足和诊断工具不完善）以及不受控制的药品部门（非处方销售抗生素、储存不当、假冒和/或过期）都有力地促进了抗生素耐药性的出现。对于产生超广谱β-内酰胺酶的肠杆菌科细菌（定植的10%至100%和感染的30%至50%），这种风险尤其令人担忧。在肠杆菌科细菌对碳青霉烯类的耐药性方面也观察到类似趋势，耐药率为10%至30%，金黄色葡萄球菌对甲氧西林的耐药性目前超过30%。这些令人不安的观察结果呼吁在这些地区制定有效的卫生政策。这些干预策略必须是综合性的，同时针对政策制定者、处方者和使用者。
