Start with me and curb "super bacteria"
In recent years, reports about "superbug" are common. It is no longer just the concern of medical workers, but has become a global problem.
"Superbacteria" actually does not refer to a specific bacteria, but generally refers to those bacteria that show resistance to at least three kinds of commonly used antibacterial drugs in clinic. Its academic name is "multi-drug-resistant bacteria".
In the face of "superbugs", only by understanding their characteristics and transmission mechanism can we better slow down their production and curb their spread.
"past lives" of Multi-drug Resistant Bacteria
Penicillin was discovered by alexander fleming in 1928. This powerful "sharp weapon" for treating bacterial infections saved countless lives in World War II. However, with the widespread use of penicillin and other antibacterial drugs, the first superbug in history-methicillin-resistant Staphylococcus aureus appeared, and then more and more superbugs appeared.
According to the report of China Bacterial Resistance Monitoring Network, the main clinical problem in China is Gram-negative bacilli which are resistant to carbapenems. The data in the first half of 2023 showed that the resistance rate of Acinetobacter baumannii to carbapenems was as high as 79.5%. These shocking data highlighted the seriousness of bacterial resistance in China.
In 2022, the authoritative medical magazine The Lancet published a survey of 204 countries and regions around the world in 2019. The study showed that antimicrobial resistance directly led to more than 1 million deaths, which even exceeded the number of people killed by malaria or HIV infection; The number of indirect deaths is even more alarming: nearly 5 million people. In 2016, the global research report on drug-resistant bacteria infection commissioned by the British government showed that by 2050, nearly 10 million people will lose their lives every year due to antimicrobial resistance.
Dr Margaret Chan, former Director-General of the World Health Organization, once pointed out that with the increasing and spreading of multidrug-resistant bacteria, common infection may once again become a fatal threat. This is not an alarmist. When human beings encounter the dilemma of no medicine available, even trivial wounds or respiratory infections may easily take their lives, and human beings will undoubtedly return to the dark period before the discovery of penicillin.
Why do drugs "fail" to bacteria?
Drug resistance of bacteria refers to the tolerance of bacteria to antibacterial drugs, which can be divided into congenital drug resistance and acquired drug resistance. Congenital drug resistance refers to the innate tolerance of bacteria to certain antibacterial drugs, which can be passed down from generation to generation; Acquired drug resistance means that bacteria "acquire" drug resistance genes due to spontaneous gene mutation or from other drug-resistant bacteria. Drug-resistant bacteria usually refer to acquired drug-resistant bacteria.
Drug resistance of bacteria is actually the result of natural selection in the process of evolution. In the process of its growth and reproduction, the reasons for promoting drug resistance involve many aspects, such as gene mutation or variation of bacteria, improper use of drugs and decreased immunity of the body, which may be the potential reasons for drug resistance.
The abuse of antibacterial drugs is an important factor leading to bacterial drug resistance. "Abuse" is mainly manifested in two aspects: unreasonable use in the treatment of human diseases and excessive and improper use in animal husbandry. Due to the selection pressure of antimicrobial agents, those bacteria with drug resistance will be naturally selected and multiply, thus accelerating the reproduction and spread of drug-resistant bacteria.
Multi-drug-resistant bacteria are mainly transmitted through contact, such as blood, sputum, urine or secretions of patients carrying multi-drug-resistant bacteria; Or contact with equipment, fabrics and pools contaminated by multi-drug resistant bacteria; For respiratory tract infection or colonization of multidrug-resistant bacteria can also be spread through droplets.
Antibacterials that have been "misunderstood"
The public’s understanding of antibacterial drugs is relatively limited, which leads to drug abuse becoming a common problem. There are 10 common misunderstandings in the use of antibacterial drugs, which need to be corrected as soon as possible:
1. Antibacterials are omnipotent anti-inflammatory drugs;
2. Do not distinguish the causes of colds, and use antibacterial drugs;
3. Antibacterials are the first choice for fever;
4. Diarrhea is inflammation, and it is best to use antibacterial drugs;
5. Broad-spectrum antibacterial drugs have stronger antibacterial ability, and the therapeutic effect is often better than narrow-spectrum antibacterial drugs for specific pathogens;
6. Newly listed and expensive antibacterial drugs are preferred;
7. The combination of multiple antimicrobial agents can effectively control infection;
8. It doesn’t matter if antibacterial drugs are frequently replaced;
9. Self-preventive use of antibacterial drugs during the high incidence of respiratory diseases in winter and spring.
10. The medication is not standardized, not enough, and the medication will be stopped if the symptoms improve slightly.
Abuse of antibacterial drugs will not only lead to bacterial resistance, but also lead to a series of serious adverse reactions, among which allergic reactions are particularly common, such as itchy skin, rash and other symptoms, and even life-threatening conditions such as anaphylactic shock may occur in severe cases; Some drugs may also cause nervous system symptoms, such as headache and dizziness. Some antibacterial drugs can also have toxic effects on hearing and kidneys; Abuse of antibacterial drugs will destroy the balance of flora in the body, which will cause a large number of inhibited bacteria to multiply and cause double infection.
Standardize drug use and prevent drug resistance
Remember 7 points.
1. Don’t buy drugs at will: Most antibacterial drugs belong to the category of prescription drugs. You must issue a doctor’s prescription when buying them, and you can’t buy them online or in a physical pharmacy at will.
2. Don’t choose your own medicine: When choosing which kind of antibacterial drugs to use, it should be judged by professional doctors according to the condition and clinical test results, not just by advertising or personal experience.
3. Do not use drugs at will: When using antibacterial drugs, we should follow the doctor’s advice to ensure that they are taken after professional diagnosis in the hospital, and do not blindly abuse drugs, especially for some daily ailments (such as colds), it is not appropriate to use antibacterial drugs easily.
4. Do not stop taking drugs without authorization: Once you use antibacterial drugs, you must follow the doctor’s instructions and take the drugs on time, according to the dosage and according to the course of treatment.
5. Pay attention to personal hygiene: frequent hand washing, more ventilation and avoiding close contact with patients are helpful to prevent infection.
6. Strengthen exercise: enhance physical fitness and immunity, and reduce the use of antibacterial drugs from the source.
7. Don’t throw drugs at will: expired drugs belong to harmful waste, so they should be thrown into the hazardous trash can to prevent criminals from recycling them. Garbage sorting, protect yourself and others.
The doctor concluded:
The increasingly serious problem of drug-resistant bacteria has become a major challenge in the field of global public health, which is attracting widespread attention from the medical community, government and society. In daily life, we should pay attention to developing healthy living habits, ensuring clean diet, actively exercising to enhance our immunity, and at the same time, we should follow scientific principles and standardize the use of antibacterial drugs. The whole society needs Qi Xin to work together to slow down the emergence of drug-resistant bacteria and curb its spread.
Text | Shen Chunmei
Deputy Chief Technician, Department of Hospital Sense, Fifth People’s Hospital Affiliated to Fudan University
Editor | Wang Jingming
Audit | Ye Haixia
Producer | Li Wenjing
Medical Support | Shanghai Medical Association Science Popularization Branch
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