Veeraraghavan Balaji, Pragasam Agila Kumari, Bakthavatchalam Yamuna Devi, Anandan Shalini, Ramasubramanian V, Swaminathan Subramanian, Gopalakrishnan Ram, Soman Rajeev, Abraham O C, Ohri Vinod C, Walia Kamini
Department of Clinical Microbiology, Christian Medical College, Vellore, Tamil Nadu, India.
Department of Infectious Diseases, Apollo Hospital, Chennai, Tamil Nadu, India.
Indian J Med Microbiol. 2018 Jul-Sep;36(3):334-343. doi: 10.4103/ijmm.IJMM_18_326.
Antimicrobial resistance (AMR) is a major public health concern across the globe, and it is increasing at an alarming rate. Multiple classes of antimicrobials have been used for the treatment of infectious diseases. Rise in the AMR limits its use and hence the prerequisite for the newer agents to combat drug resistance. Among the infections caused by Gram-negative organisms, beta-lactams are one of the most commonly used agents. However, the presence of diverse beta-lactamases hinders its use for therapy. To overcome these enzymes, beta-lactamase inhibitors are being discovered. The aim of this document is to address the burden of AMR in India and interventions to fight against this battle. This document addresses and summarises the following: The current scenario of AMR in India (antimicrobial susceptibility, resistance mechanisms and molecular epidemiology of common pathogens); contentious issues in the use of beta-lactam/beta-lactamase inhibitor as an carbapenem sparing agent; role of newer beta-lactam/beta-lactamase inhibitor agents with its appropriateness to Indian scenario and; the Indian Council of Medical Research interventions to combat drug resistance in terms of surveillance and infection control as a national response to AMR. This document evidences the need for improved national surveillance system and country-specific newer agents to fight against the AMR.
抗菌药物耐药性（AMR）是全球主要的公共卫生问题，且正以惊人的速度增长。多类抗菌药物已被用于治疗传染病。AMR的增加限制了其使用，因此需要更新的药物来对抗耐药性。在由革兰氏阴性菌引起的感染中，β-内酰胺类是最常用的药物之一。然而，多种β-内酰胺酶的存在阻碍了其在治疗中的应用。为克服这些酶，人们正在研发β-内酰胺酶抑制剂。本文档旨在阐述印度的AMR负担以及对抗这一问题的干预措施。本文档阐述并总结了以下内容：印度AMR的现状（常见病原体的抗菌药物敏感性、耐药机制和分子流行病学）；将β-内酰胺/β-内酰胺酶抑制剂作为碳青霉烯类替代药物使用时存在的争议性问题；新型β-内酰胺/β-内酰胺酶抑制剂药物在印度的适用性及其作用；以及印度医学研究理事会在监测和感染控制方面为应对AMR而采取的对抗耐药性的干预措施。本文档证明了需要改进国家监测系统以及研发适用于该国的新型药物来对抗AMR。
