Department of Pediatrics, Children Hospital, Midas Heights, Ramdaspeth, Nagpur, India.
Department of Pediatrics, All India Institute of Medical Sciences, Nagpur, India.
Indian J Pediatr. 2020 Nov;87(11):937-944. doi: 10.1007/s12098-019-03180-3. Epub 2020 Feb 5.
This article can rightly be called 'the rise of the microbial phoenix'; for, all the microbial infections whose doomsday was predicted with the discovery of antibiotics, have thumbed their noses at mankind and reemerged phoenix like. The hubris generated by Sir Alexander Fleming's discovery of Penicillin in 1928, exemplified best by the comment by William H Stewart, the US Surgeon General in 1967, "It is time to close the books on infectious diseases" has been replaced by the realisation that the threat of antibiotic resistance is, in the words of the Chief Medical Officer of England, Dame Sally Davies, "just as important and deadly as climate change and international terrorism". Antimicrobial resistance threatens to negate all the major medical advances of the last century because antimicrobial use is linked to many other fields like organ transplantation and cancer chemotherapy. Antibiotic resistance genes have been there since ancient times in response to naturally occurring antibiotics. Modern medicine has only driven further evolution of antimicrobial resistance by use, misuse, overuse and abuse of antibiotics. Resistant bacteria proliferate by natural selection when their drug sensitive comrades are removed by antibiotics. In this article the authors discuss the various causes of antimicrobial resistance and dwell in some detail on antibiotic resistance in gram-positive and gram-negative organisms. Finally they stress on the important role clinicians have in limiting the development and spread of antimicrobial resistance.
这篇文章堪称“微生物凤凰的崛起”；因为，自从抗生素问世以来，所有被预言将灭绝的微生物感染，都像凤凰涅槃一样卷土重来。亚历山大·弗莱明爵士于 1928 年发现青霉素，由此产生的傲慢，在美国 1967 年卫生与公众服务部长威廉·H·斯图尔特的评论中表现得淋漓尽致：“是时候结束传染病的历史了”，而如今人们已经意识到，正如英国首席医疗官萨莉·戴维斯所言，抗生素耐药性的威胁“与气候变化和国际恐怖主义同样重要，甚至更加致命”。抗菌药物耐药性威胁到上世纪所有重大医学进步，因为抗菌药物的使用与器官移植和癌症化疗等许多其他领域相关。抗生素耐药性基因一直存在，以应对天然存在的抗生素。现代医学通过抗生素的使用、误用、过度使用和滥用，进一步推动了抗菌药物耐药性的进化。当敏感的细菌被抗生素清除时，耐药细菌通过自然选择而大量繁殖。本文作者讨论了抗菌药物耐药性的各种原因，并详细阐述了革兰氏阳性菌和革兰氏阴性菌的抗生素耐药性。最后，他们强调了临床医生在限制抗菌药物耐药性的发展和传播方面的重要作用。
