Uhlalutyo lwakutsha nje kunye nophononongo luvelise ithemba ekukhuseleni uluntu ekuxhathiseni amayeza okubulala iintsholongwane akhawuleza abe sisoyikiso sehlabathi.
Ukufunyanwa kwe antibiotics phakathi kwiminyaka yoo-1900 yaba linyathelo elibalulekileyo kwimbali yezamayeza njengoko yayilunyango olungummangaliso kwabaninzi. intsholongwane usulelo kunye intsholongwane-zibangela izifo. Antibiotics Zakhe zabizwa ngokuba "lichiza elimangalisayo" kwaye ngoku amayeza okubulala iintsholongwane ayimfuneko kukhathalelo lwempilo olusisiseko kunye nokhathalelo lwezonyango oluphambili kunye netekhnoloji njengoko belitshintshe ngokwenene ilizwe ngokukhusela ubomi kunye nokuba yinxalenye ebalulekileyo yokunyanga iimeko ezahlukeneyo zonyango kunye nokunceda kwiinkqubo zoqhaqho olubalulekileyo. .
Ukuxhathisa kwii-antibiotics kukhula ngokukhawuleza
Antibiotics ngamayeza aveliswa ngokwendalo ziintsholongwane kwaye ayayeka okanye abulale intsholongwane ukusuka ekukhuleni. Ibaluleke kakhulu kuba intsholongwane Usulelo luye lwathwaxa uluntu lonke ixesha. Nangona kunjalo, "ukumelana" intsholongwane phuhlisa izinto zokuzikhusela ezibakhuselayo kwiziphumo ze antibiotics xa ngaphambili babebulewe ngabo. Ezi bhaktiriya ezixhathisayo ke ziyakwazi ukumelana naluphi na uhlaselo ngamayeza okubulala iintsholongwane kwaye ngenxa yoko ukuba ezi zinto intsholongwane zonyango oluqhelekileyo olubangela izifo luyeke ukusebenzela eso sifo siqhubeka nosulelo olunokuthi lunwenwe lula kwabanye. Ke, i-antibiotics "yomlingo" ngelishwa iqalile ukusilela okanye yaqala ukungasebenzi kwaye oku kubeka isoyikiso esikhulu kwinkqubo yokhathalelo lwempilo kwihlabathi liphela. Inani labaxhathisayo intsholongwane sele ibangele ukufa okungaphezulu kwama-500,000 minyaka le kwaye itshabalalisa ukusebenza kakuhle kwamayeza okubulala iintsholongwane kuthintelo kunye nokunyanga ngokuba ngumbulali ongathethiyo ngokuhlala phantse kuma-60% abantu behlabathi ngendlela ethile. Ukunganyangeki kwii-antibiotics kusongela amandla ethu okunyanga izifo ezininzi ezifana nesifo sephepha, inyumoniya kwaye siqhubele phambili kuqhaqho, unyango lomhlaza njalo njalo. Kuqikelelwa ukuba malunga nezigidi ezingama-50 abantu bayakubhubha ngenxa yosulelo oluxhathisa amayeza okubulala iintsholongwane ngo-2050 kwaye imini inokufika ngenene xa antibiotics azinakuphinda zisetyenziswe ukunyanga usulelo olubalulekileyo ngendlela olusetyenziswa ngayo ngoku. Lo mbandela wokumelana ne-antibiotics ngoku ngumxholo wezempilo obalulekileyo ekufuneka ujongwe ngokungxamisekileyo kwikamva elingcono kunye noluntu lwezonyango kunye nenzululwazi kunye noorhulumente kwihlabathi jikelele bathatha amanyathelo amaninzi ekufezekiseni le njongo.
UPhando lukaBANI: 'Ixesha lasemva kokubulala iintsholongwane'?
Umbutho wezeMpilo weHlabathi (i-WHO) ubhengeze Ukunganyangeki kwiyeza eyona nto iphambili kunye nomba wezempilo onzima nge-Global Antimicrobial Resistance Surveillance System (GLASS) eyasungulwa ngo-Oct 2015. Le nkqubo iqokelela, ihlalutya kwaye yabelane ngedatha malunga nokunganyangeki ngamayeza okubulala iintsholongwane emhlabeni wonke. Ukususela kwi-2017, amazwe angama-52 (i-25 ephezulu, i-20 ingeniso ephakathi kunye namazwe asixhenxe anengeniso ephantsi) abhalise kwi-GLASS. Yingxelo yokuqala1 iqulethe ulwazi ngamanqanaba okumelana namayeza okubulala iintsholongwane anikezelwe ngamazwe angama-22 (isiqingatha sesigidi sabathathi-nxaxheba ababhalise kuphando) ebonisa ukukhula ngesantya esothusayo- jikelele ubukhulu becala lokuxhathisa ama-62 ukuya kuma-82 epesenti. Eli nyathelo le-WHO lijolise ekudaleni ulwazi kunye nokulungelelanisa phakathi kwezizwe ezahlukeneyo ukujongana nale ngxaki inzima kwinqanaba lehlabathi.
Besinokukuthintela ukunganyangeki ngamayeza okubulala iintsholongwane kwaye sisenako
Sifike njani kweli nqanaba loluntu apho ukunganyangeki ngamayeza okubulala iintsholongwane kuye kwajika kwaba sisisongelo sehlabathi? Impendulo kuloo nto ilula kakhulu: sisebenzise ngokugqithisileyo kwaye sisebenzise kakubi antibiotics. Oogqirha baye bamisela ngokugqithisileyo antibiotics kuso nasiphi na okanye sonke isigulana kwiminyaka emininzi edlulileyo. Kwakhona, kumazwe amaninzi, ngakumbi amazwe asakhasayo aseAsia naseAfrika, antibiotics ziyafumaneka kwi-counter-the-counter kusokhemesti wasekuhlaleni kwaye zingathengwa ngaphandle kokufuna incwadi kagqirha. Kuqikelelwa ukuba ngama-50 ekhulwini elo xesha antibiotics zimiselwe usulelo oludala intsholongwane apho zingenzi nto zilungileyo kuba intsholongwane isaza kugqiba ubomi bayo (ngokukodwa phakathi kweentsuku ezi-3 ukuya kwezili-10) nokuba antibiotics zithathwe okanye azithathwa. Ngapha koko, ayilunganga kwaye iyimfihlakalo kwabaninzi malunga nokuba yeyiphi kanye kanye antibiotics (ekujoliswe kuyo intsholongwane) iya kuba nayiphi na impembelelo kwiintsholongwane! I antibiotics 'mhlawumbi' inokuthomalalisa ezinye iimpawu ezinxulumene nosulelo lwentsholongwane. Nalapho oku kusaqhubeka ukuchasana nezempilo. Ingcebiso echanekileyo kufuneka ibe kukuba akukho nyango lukhoyo kwiintsholongwane ezininzi, usulelo kufuneka luqhube kwaye kwixesha elizayo olu sulelo kufuneka luthintelwe ngenye indlela ngokulandela ucoceko olungqongqo kunye nokugcina indawo yomntu icocekile. Ngaphezu koko, antibiotics zisetyenziswa rhoqo ekwandiseni imveliso yezolimo kwihlabathi jikelele nasekutyiseni imfuyo kunye nezilwanyana ezivelisa ukutya (inkukhu, inkomo, ihagu) njengezongezo zokukhula. Ngokwenza njalo abantu babekwa emngciphekweni omkhulu wokusela i-antibiotic-resistant intsholongwane ezihlala kwezokutya okanye kwizilwanyana ezibangela ugqithiso olungqongqo loxinzelelo oluxhathisayo intsholongwane ngaphaya kwemida.
Le meko idityaniswa ngakumbi kukuba akukho ntsholongwane zintsha ziye zaphuhliswa ziinkampani zamayeza kule minyaka imbalwa idlulileyo-iklasi entsha yokugqibela ye-antibiotic yegram-negative. intsholongwane yayiyiquinolones yaphuhliswa kumashumi amane eminyaka eyadlulayo. Ke, njengoko simi ngoku, asinakucinga ngokwenene ngokuthintela Ukunganyangeki kwiyeza ngokongeza amayeza okubulala iintsholongwane amaninzi nahlukeneyo njengoko oku kuya kwenza nzima ngakumbi ukuxhathisa kunye nokudluliselwa. Abaninzi iziyobisi iinkampani ziye zabonisa ukuba ukuphuhlisa nayiphi na entsha iziyobisi okokuqala kubiza kakhulu njengoko kuyinkqubo ende efuna utyalo-mali olukhulu kunye nengeniso enokubakho evela antibiotics isezantsi kakhulu kangangokuba iinkampani azikwazi 'ukuqhekeka'. Oku kudityaniswa yinto yokuba uhlobo oluxhathisayo lunokuphuhla kwisithinteli-ntsholongwane esitsha kwindawo ethile emhlabeni kwisithuba seminyaka emibini yokusungulwa kwayo kuba kungekho sikhokelo sisemthethweni sikhoyo sokunqanda ukusetyenziswa ngokugqithisileyo kwesibulala-ntsholongwane. Oku akuvakali kunethemba ncam kurhwebo kunye nakwimbono yezonyango kwaye ngaloo ndlela kuphuhla entsha antibiotics ayisosisombululo sokuthintela ukuxhathisa kwabo.
I-WHO icebisa isicwangciso sokusebenza2 ukuthintela ukunganyangeki ngamayeza okubulala iintsholongwane:
a) Iingcali zempilo kunye nabasebenzi kufuneka benze uhlolo oluneenkcukacha ngononophelo phambi kokuba baxelelwe antibiotics ebantwini okanye kwizilwanyana. Uphononongo lweCochrane lweendlela ezahlukeneyo3 ejolise ekwehliseni ukusetyenziswa kakubi kwamayeza okubulala iintsholongwane kulo naluphi na ulungiselelo lweklinikhi lugqibe ekubeni indlela 'yeentsuku ezi-3 kagqirha' ibe yimpumelelo ngokufanelekileyo, apho isigulana esosulelekayo (esingekho intsholongwane) ugqithiselwe ukuba imeko yakhe iya kuphucuka ngeentsuku ezi-3, ngenye indlela antibiotics zinokuthathwa ukuba ngaba iimpawu ziba mandundu – nto leyo engenzekiyo njengoko usulelo lwentsholongwane sele luqhubekile ngelo xesha. b) Uluntu ngokubanzi kufuneka luzithembe ukubuza imibuzo xa lumiselwe antibiotics kwaye bamele bathabathe antibiotics kuphela xa yanelisekile ukuba iyimfuneko ngokupheleleyo. Kufuneka kwakhona bazalise idosi emiselweyo ukuthintela ukukhula okukhawulezayo kokuxhathisa intsholongwane ubunzima. c) Abalimi kunye nabafuyi bemfuyo kufuneka balandele imithetho emiselweyo yokusetyenziswa kwamayeza okubulala iintsholongwane kwaye bakwenze oko kuphela apho kuyimfuneko (umz. ukunyanga usulelo). d) Oorhulumente kufuneka baseke kwaye balandele izicwangciso zenqanaba lesizwe ukunqanda ukusetyenziswa kwamayeza okubulala iintsholongwane1. Izikhokelo ezilungiselelweyo kufuneka zisekwe ukulungiselela amazwe aphuhlileyo kunye namazwe anengeniso ephakathi nesezantsi ngokunxulumene neemfuno zawo.
Ngoku ukuba umonakalo wenzekile: ukulwa nokunganyangeki ngamayeza okubulala iintsholongwane
Ukuze singazingenisi 'kwiposti entsha antibiotics' era kunye nokubuyela kwixesha langaphambi kwe-penicillin (isithinteli-ntsholongwane sokuqala sokufunyanwa) era, uphando oluninzi lwenzeka kulo mmandla ugcwele ukungaphumeleli kunye nempumelelo ngamaxesha athile. Uphononongo oluninzi lwakutsha nje lubonisa iindlela zokulwa kwaye mhlawumbi ukubuyisela umva ukunganyangeki ngamayeza okubulala iintsholongwane. Uphononongo lokuqala olupapashwe kwi Ijenali ye-Antimicrobial Chemotherapy4 ibonisa ukuba nini intsholongwane baxhathise, yenye yeendlela abazisebenzisayo ukunqanda antibiotics isenzo kukwenza i-enzyme (i-β-lactamase) etshabalalisa nasiphi na isibulala-ntsholongwane esizama ukungena kwiseli (yonyango). Ngoko ke, iindlela zokuthintela ukusebenza kwee-enzyme ezinjalo zinokubuyisela ngempumelelo ukuxhathisa amayeza okubulala iintsholongwane. Kwisifundo sesibini esilandelayo esivela kwiqela elifanayo kwiYunivesithi yaseBristol, e-UK kodwa ngokubambisana neYunivesithi yaseOxford epapashwe kwi. I-Molecular Microbiology5, bahlalutya ukusebenza kweentlobo ezimbini ze-inhibitors ze-enzymes ezinjalo. Ezi zithinteli (ezisuka kwiklasi ye-bicyclic boronate) zibonwe zisebenza kakhulu kuhlobo oluthile lwesithinteli-ntsholongwane (i-aztreonam) kangangokuba phambi kwesi sithinteli, iyeza lokubulala iintsholongwane liye lakwazi ukubulala abaninzi abanganyangekiyo. intsholongwane. Ezimbini kwezi inhibitors i-avibactam kunye ne-vaborbactam - ngoku ziphantsi kovavanyo lweklinikhi kwaye ziye zakwazi ukusindisa ubomi bomntu ophethwe sisifo esinganyangekiyo.Ababhali baye baphumelela ngohlobo oluthile kuphela lo antibiotic, nangona kunjalo, umsebenzi wabo uye wavelisa ithemba ekubuyiseleni umva ukuxhathisa amayeza okubulala iintsholongwane.
Kwesinye isifundo esipapashwe kwi Iingxelo zeSayensi6, abaphandi base-Université de Montréal baye baqulunqa indlela entsha yokuthintela ukudluliselwa kokuchasana phakathi kweebhaktheriya enye yeendlela zokuchasana kwe-antibiotics zisasazeka kwizibhedlele kunye neeyunithi zempilo. Iijini ezinoxanduva lokwenza iibhaktheriya zixhathise zifakwe kwii-plasmids (ezincinci DNA Iqhekeza elinokuthi liziphindaphinde ngokuzimeleyo) kwaye ezi plasmids zigqithiselwa phakathi kwebhaktheriya, ngaloo ndlela isasaza ukuxhathisa. intsholongwane kude nabanzi. Abaphandi bavavanya ithala leencwadi leemolekyuli ezincinci zeekhemikhali ezinokubophelela kwiprotheyini (TraE) eyimfuneko kolu dluliselo lweplasmid. Indawo yokubopha inhibitor iyaziwa kwiprotheyini ye-3D yesakhiwo semolekyuli kwaye kwabonwa ukuba xa ii-inhibitors ezinokuthi zibotshelelwe kwiprotheni, ukudluliselwa kwe-antibiotic-resistant, i-gene-carrying plasmids yancitshiswa kakhulu ngaloo ndlela iphakamisa iqhinga elinokubakho lokukhawulela kunye nokubuyisela umva isibulala-ntsholongwane. ukuxhathisa. Nangona kunjalo, kulolu hlobo lokufunda i 3D Ulwakhiwo lwemolekyuli yeprotheyini iyafuneka nto leyo eyenza ukuba ibe ngumda kancinane njengoko iiproteni ezininzi zisaza kubonakaliswa ngokwesakhiwo. Nangona kunjalo, umbono uyakhuthaza kwaye ezo zithinteli zinokudlala indima ebalulekileyo kukhathalelo lwempilo lwemihla ngemihla.
Ukuchaswa kweAntibiotic kusongela kwaye kujongela phantsi amashumi eminyaka ophuculo kunye neenzuzo ezenziweyo ebantwini. ukhathalelo lwempilo kwaye Phuhliso kunye nokuphunyezwa kwalo msebenzi kuya kuba nempembelelo enkulu ngqo kwisakhono sabantu ukuba baphile ubomi obunempilo.
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{Unokufunda iphepha lokuqala lophando ngokunqakraza ikhonkco le-DOI elinikwe ngezantsi kuluhlu lwemithombo ecatshulweyo (s)}
Umthombo (s)
1. NGUBANI. Ingxelo yeGlobal antimicrobial resistance surveillance system (GLASS). http://www.who.int/glass/resources/publications/early-implementation-report/en/ [Ifunyenwe ngoJanuwari 29 2018].
2. NGUBANI. Indlela yokuyeka ukuxhathisa amayeza okubulala iintsholongwane? Nali umyalelo we-WHO. http://www.who.int/mediacentre/commentaries/stop-antibiotic-resistance/en/. [Ifikeleleke ngoFebruwari 10 2018].
3. UArnold SR. kunye noStraus SE. 2005. Ungenelelo ngoncedo lokuphucula iindlela zokumisela i-antibiotics kukhathalelo lwe-ambulatory.Cochrane Database Syst Rev. 19(4). https://doi.org/10.1002/14651858.CD003539.pub2
4. UJiménez-Castellanos JC. okqhubekayo. 2017. Iinguqu ze-envelope zeproteome eziqhutywe yi-RamA overproduction kwi-Klebsiella pneumoniae ephucula ukufumana ukuxhathisa kwe-β-lactam. Ijenali ye-Antimicrobial Chemotherapy. 73(1) https://doi.org/10.1093/jac/dkx345
5. Calvopiña K. et al.2017. Ulwazi ngolwakhiwo/oomatshini ekusebenzeni kwe-nonclassical β-lactamase inhibitors ngokuchasene kakhulu ne-Stenotrophomonasmaltophilia yokunganyangeki kweziyobisi. I-Molecular Microbiology. 106(3). https://doi.org/10.1111/mmi.13831
6. UCasu B. et al. 2017. Ukuhlolwa kwe-fragment-based screening ichonga iithagethi zenoveli kwi-inhibitors ye-conjugative transfer of antimicrobial resistance by plasmid pKM101. Iingxelo zeSayensi. 7(1). https://doi.org/10.1038/s41598-017-14953-1
