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*For medical professionals to read and refer
to jointly prevent antimicrobial resistance, 30 years ago, when Hu Bijie was the attending physician, he remembered that there was a cephalosporin drug called "Pioneer Bi", "This was a very powerful drug at that time, when hospitalized patients had severe infections, they could not get it right, and many people were really saved.
"
。
However, Pioneer will soon become less "powerful", and more and more patients still cannot control the infection
after use.
At this time, a broad-spectrum antibiotic - Tai Neng
.
"More than 20 years ago, when the patient was very sick and many antibiotics were ineffective, the doctor would ask the patient's family 'Is there money', and if the family said 'don't think about money', the doctor would use Tai Neng, what was the concept of 2,000 yuan a day! But as long as there is money, infected patients can be saved
.
Today, Hu Bijie, who is the director of the Department of Infectious Diseases at Zhongshan Hospital affiliated to Fudan University and enjoys a high reputation in the domestic and even international infectious disease community, sighed: "In the past, antibiotics were expensive, but now even if you have money, if you use all the antibiotics, it may not be curable, this is because the resistance of pathogens has increased, and the pathogen spectrum has also changed, and the requirements for doctors' knowledge and ability are getting higher and higher.
"
。 "
The Lancet released earlier this year the most comprehensive analysis of the global impact of antibiotic resistance (AMR) to date, estimating that antibiotic-resistant infections were directly responsible for 1.
27 million deaths and 4.
95 million indirectly in 2019
.
"Antimicrobial resistance may not be as urgent as a pandemic, but it is just as dangerous
.
" WHO Director-General Tedros Adhanom Ghebreyesus warned that the problem of drug resistance threatens to undermine a century of medical progress and leave us defenseless against infections that can be easily treated today
.
Etiological diagnosis is the first weapon
of the infectious disease department, what is more unlucky than being bitten by a stray dog while walking on the road? It was the dog who also had tuberculosis
.
Director Hu Bijie once encountered such an "unlucky" patient
.
The patient is an anesthesiologist who has been vaccinated
against rabies after being bitten by a large stray dog.
Later, she began to have a fever, and the wound was red and swollen and oozing, accompanied by swollen inguinal lymph nodes
.
She has done two wound debridements at the local hospital and used many antibacterial drugs, but she has not been able to control the wound infection
.
When he came to Hu Bijie's clinic, the patient had been bitten for more than a month
.
Her wound was like a "cave", the mouth of the cave was small, but the inside was large and deep, which was a hole
left by two debridements.
The local hospital also gave her an inguinal lymph node biopsy and went for pathogenic genetic testing, which detected Mycobacterium abscessis, a rare non-tuberculous mycobacterium, and the local hospital used four drugs combined with anti-infection treatment, but still could not control the wound infection
.
The stray dog's oral flora is complex, and Hu Bijie suspects that the patient has other infections that have not been detected
.
HE FOUND THAT THE PATIENT'S TUBERCULOSIS INFECTION INDEX (T-SPOT.
TB) WAS A/B=27/32, WHICH IS NOT VERY HIGH, BUT IT IS NOT LOW
.
Chest CT of the patient has ruled out tuberculosis, but is the wound infected with tuberculosis?
In order to confirm the diagnosis, Hu Bijie had the patient do percutaneous puncture of the wound abscess drainage, and sent the exudate and drainage fluid for various examinations
.
The culture of Mycobacterium tuberculosis takes dozens of days, and the addition of anti-tuberculosis treatment based on the evidence of T-SPOT.
TB alone is somewhat presumptuous, but the patient is very painful
.
In the end, Hu Bijie decided not to use first-line anti-tuberculosis drugs and added a powerful second-line anti-tuberculosis drug linezolid, which has both anti-tuberculosis mycobacteria and non-tuberculous mycobacteria
.
Hu Bijie is not 100% sure that the patient may be infected with Mycobacterium tuberculosis, but he is 80% confident that the patient
can be cured.
A month later, the culture results came back and were positive
for Mycobacterium tuberculosis.
This confirmed the previous prediction - in addition to infection with nontuberculous mycobacteria, the patient was also infected with Mycobacterium
tuberculosis.
This is why
the patient's wound does not heal.
After the cause was found, the patient's treatment plan was adjusted, and after the standard treatment against two mycobacteria, the patient's
wound was completely healed 100 days before the dog bite.
This patient story is included in Director Hu Bijie's recently published "Medical Detective - The Story of the Department of Infectious Diseases", which records the stories of nearly 40 patients with difficult infectious diseases, and the diagnosis process of each patient is as tortuous and complex as the detective, but unlike the detective, when the real culprit of the infection is found, it is also when
the patient is saved.
Director Hu Bijie presented the newly published book
"Detective Cases in the Medical Circle".
( Photo / Tian Dongliang)
Hu Bijie regards etiological diagnosis as the first weapon of the infectious disease department, and only when the diagnosis is clear can it be accurately treated
.
The patient who was bitten by a stray dog eventually relied on traditional cultivation methods to find the real murderer, but more often to find the real murderer, it depends on advanced diagnostic technology
.
"The introduction of new diagnostic technologies is very important, but many people still ignore it, and the second generation gene sequencing technology that we use in Zhongshan Hospital is particularly good now
.
"
Three weeks ago, Hu Bijie met a patient from Gansu in the outpatient clinic, 35 years old, hydrocephalus, inflammatory indicators are very high, but the pathogen of infection is unknown, before coming to Shanghai for treatment, has been treated for half a year, local tuberculosis treatment, not only not cured, the patient's eyes can not see clearly, the local hospital let the patient go to Shanghai Zhongshan Hospital to find Director
Hu Bijie.
"This patient stayed with us for three days, and with the help of second-generation gene sequencing technology, we figured out his pathogen, which was infected with swine taeniasis in the brain, and after targeted treatment, the patient's
eyes could soon see again 。 Hu Bijie said, "China's second-generation gene sequencing technology is more popular than European and American households, because the conventional microbial testing technology in European and American countries is better, and the price of second-generation gene sequencing is too expensive, China is now about 3,000 yuan, only one-third of foreign countries, but now European and American countries are also promoting this technology
.
" In
2018, at the European Annual Conference on Clinical Microbial Infectious Diseases, Hu Bijie's team published an article, as the first team in China to carry out large-scale pathogenic microbial metagenosequencing technology and establish the first localized clinical sequencing platform in China, in more than half a year in 2017, they used second-generation gene sequencing technology to diagnose more than 500 cases of various difficult infections, and compiled and published This was the world's first report
on the use of large-sample next-generation gene sequencing in the diagnosis and treatment of clinical infectious diseases.
The "Expert Consensus on the Clinical Application of Chinese Metagenomics Second-Generation Sequencing Technology for the Detection of Infectious Pathogens" released in 2020 clarifies that etiological diagnosis is always the most important link in the diagnosis of infectious diseases, and second-generation sequencing detection can cover a wide range of pathogens, and viruses, bacteria, fungi, and parasites can be detected at the same time, regardless of the success of clinical sample culture.
As long as it contains detectable DNA or RNA, next-generation sequencing is more meaningful
when applied to patients with clinically intractable diseases or immunosuppressed diseases because it can detect pathogens that cannot be detected by other traditional means.
Hu Bijie said that to standardize the rational use of antibiotics, to shift from empirical treatment to targeted treatment as much as possible, in the past, mainly relying on culture, low positive rate, now microbial molecular diagnosis technology allows us to accurately diagnose gradually become a reality, although it can not reach 100%, but it is greatly improved than before, in many cases can make doctors less detours
.
Not long ago, Hu Bijie consulted a patient, the patient is over 60 years old, there is a large area of inflammation in the lungs, after ruling out the new crown pneumonia, the doctor gave him a lot of advanced antibiotics, but the effect was not obvious, the patient's condition became more and more serious, began to take oxygen, and then could only be intubated
.
Later, the second-generation gene sequencing was done, and the results were found to be Chlamydia psittaci, which is an atypical pathogen that if not treated correctly in time, the patient will die
of severe pneumonia.
"After diagnosing the pathogen, I told them the correct treatment, which is a tetracycline oral drug, called doxycycline, the cost of medicine is only a few dollars a day, the doctor over there asked me if I still need to use advanced antibiotics, I said that it is definitely not needed, doxycycline can be said to be a miracle medicine
for this infection.
"
Hu Bijie also pointed out that the second-generation gene sequencing technology has higher requirements for the interpretation of test results, because compared with traditional culture technology, second-generation gene sequencing can detect dozens or even one or two hundred microorganisms, which one is the real culprit? This requires a high level of microbiology literacy on the part of the doctor
.
"Foreign doctors engaged in infectious diseases have a deep understanding of microorganisms, but in China such doctors are rare, if you want to be a good infectious doctor, you must make up this course
.
" We have also translated Baylor and Scott Diagnostic Microbiology, known in the United States as the 'first benchmark' reference book for professional microbiologists, into Chinese and will soon be published
.
"
Every month, Hu Bijie will arrange a doctor to be responsible for consultation in all departments of the hospital
.
" 15~20 patients can be consulted a day every day, and the maximum number is 27 a day
.
Many departments in the hospital have become more and more trusting of us, and feel that the guidance of the infectious disease department can really solve the problem, and they have a lot of inspiration
for them.
”
If the pathogen is not clearly diagnosed, blind use of antibiotics, in addition to increasing medical costs, Hu Bijie said that it will also increase the patient's liver and kidney toxic reactions, and induce drug resistance, so the premise of rational use of antibiotics is to emphasize accurate diagnosis
.
Will we enter the post-antibiotic era?
Although the anesthesiologist who was bitten by a stray dog was unlucky, fortunately, she was not infected with drug-resistant tuberculosis bacteria
.
At present, the cure rate of drug-resistant tuberculosis is 50%~60%, and the eradication rate of Helicobacter pylori bismuth quadruple treatment is 80%~90%, and the main reason for the inability to achieve 100% cure rate is drug resistance
.
If drug resistance is not effectively contained, or new treatments are not developed in time, the cure rate will fall
again.
In 2016, Margaret Chan, then Director-General of the World Health Organization, spoke at the High-Level Symposium on "Antimicrobial Resistance", saying that the worsening problem of antimicrobial resistance, which exists in every region of the world, has become an urgent global health crisis
.
A few years after the advent of antibiotics, people knew that bacteria would develop resistance, but the world still strides towards the post-antibiotic era, that is, as more and more bacteria become resistant to antibiotics, the world seems to return to the era
when there were no antibiotics.
Peng, WHO's coordinator
for antibiotic resistance, pointed out at a briefing at Geneva headquarters that antibiotic resistance is no longer a prediction of the future, but a reality that is happening around the world, and seriously threatens the ability of humans to treat common infections
。 At the same time, we will lose the ability to effectively treat a range of serious diseases, including bloodstream infections, pneumonia, tuberculosis, malaria and AIDS
.
In addition, without effective antimicrobials to prevent and treat infections, the risks of organ transplantation, cancer chemotherapy and major surgery are significantly increased and the chances of success are greatly reduced
.
ReAct is a global network
dedicated to tackling antibiotic resistance.
On October 27, the website published the story of a premature baby born in Sweden who died of
sepsis.
The infection in this baby, who had only survived 8 days in this world, was caused by the drug-resistant Klebsiella, and antibiotics were ineffective
against her.
Infection is one of the biggest health threats to newborns, especially prematurity, with sepsis affecting 4 million newborns worldwide each year and accounting for 15% of all neonatal deaths, a threat
exacerbated by antibiotic resistance.
Despite the growing and urgent problem of drug resistance, the world's response to it has not gone far enough
.
In 2017, WHO published the first list of antibiotic resistance "priority pathogens", which includes a list of the 12 bacterial species that pose the greatest threat to human health, and divides the list into three categories according to the urgency of the need for new antibiotics: extremely important, very important and moderately important
.
Among the most important catalogs are: carbapenem-resistant Acinetobacter baumannii, carbapene-resistant Pseudomonas aeruginosa, carbapenem-tolerant/ultra-broad-spectrum β-lactamase (ESBL) Enterobacteriaceae
.
Hu Bijie said that this is also what ordinary people usually call superbugs, "In fact, academically we do not talk about superbugs, but pan-drug-resistant bacteria or all-drug resistant bacteria
.
" The vast majority of antibiotics are resistant, only sensitive to groups of 1-3 antibiotics, called pan-resistant bacteria, the most serious at present is mainly carbapenem-resistant bacteria
.
"
Superbugs are actually less encountered in infectious disease departments and are most often found in intensive care units (ICUs)
.
" ICU patients experience the most rescue, antibiotics are used more, invasive examinations are more, patients often have a variety of tubes inserted in the body, if the infection control is not in place, it is easy to occur
.
"
Today, when the situation of drug resistance is becoming more and more serious, Director Hu Bijie pays more and more attention to etiological diagnosis
.
" It's not that there have to be many new antibiotics, it's
wrong.
The first thing to do is to clarify the etiological diagnosis, but also depends on the drug resistance, and many times the patient's infection situation is much
more complicated than expected.
"
In fact, we can hardly hope for the development of
new antibiotics when it comes to tackling drug resistance.
WHO publishes an annual Report on Alternative Antibiotics, which evaluates antibiotics
in clinical testing as well as early product development.
The 2020 "Report" revealed that alternative drug development is in a near-"static" state, with only a few antibiotics approved by regulators in recent years
.
Most of these development-stage drugs have limited
clinical efficacy compared to existing therapies.
WHO notes that almost all new antibiotics that have been put on the market in recent decades are variants of various antibiotic drugs developed in the 80s, so resistance is expected to develop soon after these so-called new drugs are on the market
.
If new antibiotics cannot be expected, the world needs to explore other innovative ways
to treat bacterial infections.
For the first time, the 2021 Alternative Antimicrobial Report includes a comprehensive overview of non-traditional antimicrobials, highlighting 27 non-traditional antimicrobials in development, including antibodies, bacteriophages, and therapies that support a patient's immune response and weaken bacteria
.
Hu Bijie also attaches great importance to the prevention
of infection.
"Why are there so many resistant bacteria in some sectors? A very important reason is that infection control is not in place, drug-resistant bacteria spread, if infection control is done, antibiotic use is reduced, and the emergence of drug-resistant bacteria will fall
.
Therefore, the capacity of an infectious disease department of a hospital must first be improved, and then affect the ability of doctors in other departments
.
As
an infectious disease doctor, Director Hu Bijie also often teaches patients how to prevent infections
that may occur in daily life.
Hu Bijie encountered a patient with a fungal lung infection, and many antibiotics were ineffective, and later after comprehensive evaluation, it was considered that he was a fungal infection
.
Because the patient reported that the home had been flooded and the floor was moldy
.
Later, the patient pried open the floor of the home and found that it was covered with mold
underneath.
If the patient cannot find the source of the environmental infection, the infection
will occur again soon after the cure is returned.
He also treated a patient with pulmonary aspergillosis, which recurred after six months, and the lesions in the lungs increased
significantly.
"I said, you must have been exposed to moldy things recently, she finally remembered, the rice in the attic at home was moldy, reluctant to throw it away, washed and eaten, every time she opened the lid to scoop rice, mold spores would fly into the air and be inhaled
by her.
"
As an infectious disease doctor, Director Hu Bijie said that he is neither pessimistic nor optimistic
about the future.
"Optimism is not enough, after all, we are less and less of good antibiotics available, to say pessimistic, you think, in the past we were also pessimistic about tumors, now there are more and more treatments for tumors, and even become a chronic disease
.
"
to jointly prevent antimicrobial resistance, 30 years ago, when Hu Bijie was the attending physician, he remembered that there was a cephalosporin drug called "Pioneer Bi", "This was a very powerful drug at that time, when hospitalized patients had severe infections, they could not get it right, and many people were really saved.
"
。
However, Pioneer will soon become less "powerful", and more and more patients still cannot control the infection
after use.
At this time, a broad-spectrum antibiotic - Tai Neng
.
"More than 20 years ago, when the patient was very sick and many antibiotics were ineffective, the doctor would ask the patient's family 'Is there money', and if the family said 'don't think about money', the doctor would use Tai Neng, what was the concept of 2,000 yuan a day! But as long as there is money, infected patients can be saved
.
Today, Hu Bijie, who is the director of the Department of Infectious Diseases at Zhongshan Hospital affiliated to Fudan University and enjoys a high reputation in the domestic and even international infectious disease community, sighed: "In the past, antibiotics were expensive, but now even if you have money, if you use all the antibiotics, it may not be curable, this is because the resistance of pathogens has increased, and the pathogen spectrum has also changed, and the requirements for doctors' knowledge and ability are getting higher and higher.
"
。 "
The Lancet released earlier this year the most comprehensive analysis of the global impact of antibiotic resistance (AMR) to date, estimating that antibiotic-resistant infections were directly responsible for 1.
27 million deaths and 4.
95 million indirectly in 2019
.
"Antimicrobial resistance may not be as urgent as a pandemic, but it is just as dangerous
.
" WHO Director-General Tedros Adhanom Ghebreyesus warned that the problem of drug resistance threatens to undermine a century of medical progress and leave us defenseless against infections that can be easily treated today
.
November 18~24 is World Antimicrobial Awareness Week, and this year's theme is "Working together to prevent antimicrobial resistance"
.
Antimicrobials include antibiotics, antivirals, antifungals and antiprotozoals, and to effectively curb antimicrobial resistance, WHO calls on all sectors to use antimicrobials with caution and take other preventive measures
.
Etiological diagnosis is the first weapon
of the infectious disease department, what is more unlucky than being bitten by a stray dog while walking on the road? It was the dog who also had tuberculosis
.
Director Hu Bijie once encountered such an "unlucky" patient
.
The patient is an anesthesiologist who has been vaccinated
against rabies after being bitten by a large stray dog.
Later, she began to have a fever, and the wound was red and swollen and oozing, accompanied by swollen inguinal lymph nodes
.
She has done two wound debridements at the local hospital and used many antibacterial drugs, but she has not been able to control the wound infection
.
When he came to Hu Bijie's clinic, the patient had been bitten for more than a month
.
Her wound was like a "cave", the mouth of the cave was small, but the inside was large and deep, which was a hole
left by two debridements.
The local hospital also gave her an inguinal lymph node biopsy and went for pathogenic genetic testing, which detected Mycobacterium abscessis, a rare non-tuberculous mycobacterium, and the local hospital used four drugs combined with anti-infection treatment, but still could not control the wound infection
.
The stray dog's oral flora is complex, and Hu Bijie suspects that the patient has other infections that have not been detected
.
HE FOUND THAT THE PATIENT'S TUBERCULOSIS INFECTION INDEX (T-SPOT.
TB) WAS A/B=27/32, WHICH IS NOT VERY HIGH, BUT IT IS NOT LOW
.
Chest CT of the patient has ruled out tuberculosis, but is the wound infected with tuberculosis?
In order to confirm the diagnosis, Hu Bijie had the patient do percutaneous puncture of the wound abscess drainage, and sent the exudate and drainage fluid for various examinations
.
The culture of Mycobacterium tuberculosis takes dozens of days, and the addition of anti-tuberculosis treatment based on the evidence of T-SPOT.
TB alone is somewhat presumptuous, but the patient is very painful
.
In the end, Hu Bijie decided not to use first-line anti-tuberculosis drugs and added a powerful second-line anti-tuberculosis drug linezolid, which has both anti-tuberculosis mycobacteria and non-tuberculous mycobacteria
.
Hu Bijie is not 100% sure that the patient may be infected with Mycobacterium tuberculosis, but he is 80% confident that the patient
can be cured.
A month later, the culture results came back and were positive
for Mycobacterium tuberculosis.
This confirmed the previous prediction - in addition to infection with nontuberculous mycobacteria, the patient was also infected with Mycobacterium
tuberculosis.
This is why
the patient's wound does not heal.
After the cause was found, the patient's treatment plan was adjusted, and after the standard treatment against two mycobacteria, the patient's
wound was completely healed 100 days before the dog bite.
This patient story is included in Director Hu Bijie's recently published "Medical Detective - The Story of the Department of Infectious Diseases", which records the stories of nearly 40 patients with difficult infectious diseases, and the diagnosis process of each patient is as tortuous and complex as the detective, but unlike the detective, when the real culprit of the infection is found, it is also when
the patient is saved.
Director Hu Bijie presented the newly published book
"Detective Cases in the Medical Circle".
( Photo / Tian Dongliang)
Hu Bijie regards etiological diagnosis as the first weapon of the infectious disease department, and only when the diagnosis is clear can it be accurately treated
.
The patient who was bitten by a stray dog eventually relied on traditional cultivation methods to find the real murderer, but more often to find the real murderer, it depends on advanced diagnostic technology
.
"The introduction of new diagnostic technologies is very important, but many people still ignore it, and the second generation gene sequencing technology that we use in Zhongshan Hospital is particularly good now
.
"
Three weeks ago, Hu Bijie met a patient from Gansu in the outpatient clinic, 35 years old, hydrocephalus, inflammatory indicators are very high, but the pathogen of infection is unknown, before coming to Shanghai for treatment, has been treated for half a year, local tuberculosis treatment, not only not cured, the patient's eyes can not see clearly, the local hospital let the patient go to Shanghai Zhongshan Hospital to find Director
Hu Bijie.
"This patient stayed with us for three days, and with the help of second-generation gene sequencing technology, we figured out his pathogen, which was infected with swine taeniasis in the brain, and after targeted treatment, the patient's
eyes could soon see again 。 Hu Bijie said, "China's second-generation gene sequencing technology is more popular than European and American households, because the conventional microbial testing technology in European and American countries is better, and the price of second-generation gene sequencing is too expensive, China is now about 3,000 yuan, only one-third of foreign countries, but now European and American countries are also promoting this technology
.
" In
2018, at the European Annual Conference on Clinical Microbial Infectious Diseases, Hu Bijie's team published an article, as the first team in China to carry out large-scale pathogenic microbial metagenosequencing technology and establish the first localized clinical sequencing platform in China, in more than half a year in 2017, they used second-generation gene sequencing technology to diagnose more than 500 cases of various difficult infections, and compiled and published This was the world's first report
on the use of large-sample next-generation gene sequencing in the diagnosis and treatment of clinical infectious diseases.
The "Expert Consensus on the Clinical Application of Chinese Metagenomics Second-Generation Sequencing Technology for the Detection of Infectious Pathogens" released in 2020 clarifies that etiological diagnosis is always the most important link in the diagnosis of infectious diseases, and second-generation sequencing detection can cover a wide range of pathogens, and viruses, bacteria, fungi, and parasites can be detected at the same time, regardless of the success of clinical sample culture.
As long as it contains detectable DNA or RNA, next-generation sequencing is more meaningful
when applied to patients with clinically intractable diseases or immunosuppressed diseases because it can detect pathogens that cannot be detected by other traditional means.
Hu Bijie said that to standardize the rational use of antibiotics, to shift from empirical treatment to targeted treatment as much as possible, in the past, mainly relying on culture, low positive rate, now microbial molecular diagnosis technology allows us to accurately diagnose gradually become a reality, although it can not reach 100%, but it is greatly improved than before, in many cases can make doctors less detours
.
Not long ago, Hu Bijie consulted a patient, the patient is over 60 years old, there is a large area of inflammation in the lungs, after ruling out the new crown pneumonia, the doctor gave him a lot of advanced antibiotics, but the effect was not obvious, the patient's condition became more and more serious, began to take oxygen, and then could only be intubated
.
Later, the second-generation gene sequencing was done, and the results were found to be Chlamydia psittaci, which is an atypical pathogen that if not treated correctly in time, the patient will die
of severe pneumonia.
"After diagnosing the pathogen, I told them the correct treatment, which is a tetracycline oral drug, called doxycycline, the cost of medicine is only a few dollars a day, the doctor over there asked me if I still need to use advanced antibiotics, I said that it is definitely not needed, doxycycline can be said to be a miracle medicine
for this infection.
"
Hu Bijie also pointed out that the second-generation gene sequencing technology has higher requirements for the interpretation of test results, because compared with traditional culture technology, second-generation gene sequencing can detect dozens or even one or two hundred microorganisms, which one is the real culprit? This requires a high level of microbiology literacy on the part of the doctor
.
"Foreign doctors engaged in infectious diseases have a deep understanding of microorganisms, but in China such doctors are rare, if you want to be a good infectious doctor, you must make up this course
.
" We have also translated Baylor and Scott Diagnostic Microbiology, known in the United States as the 'first benchmark' reference book for professional microbiologists, into Chinese and will soon be published
.
"
Every month, Hu Bijie will arrange a doctor to be responsible for consultation in all departments of the hospital
.
" 15~20 patients can be consulted a day every day, and the maximum number is 27 a day
.
Many departments in the hospital have become more and more trusting of us, and feel that the guidance of the infectious disease department can really solve the problem, and they have a lot of inspiration
for them.
”
If the pathogen is not clearly diagnosed, blind use of antibiotics, in addition to increasing medical costs, Hu Bijie said that it will also increase the patient's liver and kidney toxic reactions, and induce drug resistance, so the premise of rational use of antibiotics is to emphasize accurate diagnosis
.
This is also the basic requirement
for China to curb antibiotic resistance.
On October 25 this year, the National Action Plan for Curbing Microbial Drug Resistance (2022-2025) jointly issued by the National Health Commission, the Department of Education, the Department of Science and Technology and other departments requires that the construction of infectious disease departments in general hospitals above the second level be strengthened, and the diagnosis and treatment of bacterial fungal infections should be standardized; Strengthen the construction of clinical microbiology laboratories and improve the ability of etiological diagnosis; Vigorously train clinical pharmacists in the field of anti-infection, and take the lead in appointing full-time pharmacists
in key departments such as pediatrics.
Will we enter the post-antibiotic era?
Although the anesthesiologist who was bitten by a stray dog was unlucky, fortunately, she was not infected with drug-resistant tuberculosis bacteria
.
At present, the cure rate of drug-resistant tuberculosis is 50%~60%, and the eradication rate of Helicobacter pylori bismuth quadruple treatment is 80%~90%, and the main reason for the inability to achieve 100% cure rate is drug resistance
.
If drug resistance is not effectively contained, or new treatments are not developed in time, the cure rate will fall
again.
In 2016, Margaret Chan, then Director-General of the World Health Organization, spoke at the High-Level Symposium on "Antimicrobial Resistance", saying that the worsening problem of antimicrobial resistance, which exists in every region of the world, has become an urgent global health crisis
.
A few years after the advent of antibiotics, people knew that bacteria would develop resistance, but the world still strides towards the post-antibiotic era, that is, as more and more bacteria become resistant to antibiotics, the world seems to return to the era
when there were no antibiotics.
Peng, WHO's coordinator
for antibiotic resistance, pointed out at a briefing at Geneva headquarters that antibiotic resistance is no longer a prediction of the future, but a reality that is happening around the world, and seriously threatens the ability of humans to treat common infections
。 At the same time, we will lose the ability to effectively treat a range of serious diseases, including bloodstream infections, pneumonia, tuberculosis, malaria and AIDS
.
In addition, without effective antimicrobials to prevent and treat infections, the risks of organ transplantation, cancer chemotherapy and major surgery are significantly increased and the chances of success are greatly reduced
.
ReAct is a global network
dedicated to tackling antibiotic resistance.
On October 27, the website published the story of a premature baby born in Sweden who died of
sepsis.
The infection in this baby, who had only survived 8 days in this world, was caused by the drug-resistant Klebsiella, and antibiotics were ineffective
against her.
Infection is one of the biggest health threats to newborns, especially prematurity, with sepsis affecting 4 million newborns worldwide each year and accounting for 15% of all neonatal deaths, a threat
exacerbated by antibiotic resistance.
Despite the growing and urgent problem of drug resistance, the world's response to it has not gone far enough
.
In 2017, WHO published the first list of antibiotic resistance "priority pathogens", which includes a list of the 12 bacterial species that pose the greatest threat to human health, and divides the list into three categories according to the urgency of the need for new antibiotics: extremely important, very important and moderately important
.
Among the most important catalogs are: carbapenem-resistant Acinetobacter baumannii, carbapene-resistant Pseudomonas aeruginosa, carbapenem-tolerant/ultra-broad-spectrum β-lactamase (ESBL) Enterobacteriaceae
.
Hu Bijie said that this is also what ordinary people usually call superbugs, "In fact, academically we do not talk about superbugs, but pan-drug-resistant bacteria or all-drug resistant bacteria
.
" The vast majority of antibiotics are resistant, only sensitive to groups of 1-3 antibiotics, called pan-resistant bacteria, the most serious at present is mainly carbapenem-resistant bacteria
.
"
Superbugs are actually less encountered in infectious disease departments and are most often found in intensive care units (ICUs)
.
" ICU patients experience the most rescue, antibiotics are used more, invasive examinations are more, patients often have a variety of tubes inserted in the body, if the infection control is not in place, it is easy to occur
.
"
Today, when the situation of drug resistance is becoming more and more serious, Director Hu Bijie pays more and more attention to etiological diagnosis
.
" It's not that there have to be many new antibiotics, it's
wrong.
The first thing to do is to clarify the etiological diagnosis, but also depends on the drug resistance, and many times the patient's infection situation is much
more complicated than expected.
"
In fact, we can hardly hope for the development of
new antibiotics when it comes to tackling drug resistance.
WHO publishes an annual Report on Alternative Antibiotics, which evaluates antibiotics
in clinical testing as well as early product development.
The 2020 "Report" revealed that alternative drug development is in a near-"static" state, with only a few antibiotics approved by regulators in recent years
.
Most of these development-stage drugs have limited
clinical efficacy compared to existing therapies.
WHO notes that almost all new antibiotics that have been put on the market in recent decades are variants of various antibiotic drugs developed in the 80s, so resistance is expected to develop soon after these so-called new drugs are on the market
.
If new antibiotics cannot be expected, the world needs to explore other innovative ways
to treat bacterial infections.
For the first time, the 2021 Alternative Antimicrobial Report includes a comprehensive overview of non-traditional antimicrobials, highlighting 27 non-traditional antimicrobials in development, including antibodies, bacteriophages, and therapies that support a patient's immune response and weaken bacteria
.
Hu Bijie also attaches great importance to the prevention
of infection.
"Why are there so many resistant bacteria in some sectors? A very important reason is that infection control is not in place, drug-resistant bacteria spread, if infection control is done, antibiotic use is reduced, and the emergence of drug-resistant bacteria will fall
.
Therefore, the capacity of an infectious disease department of a hospital must first be improved, and then affect the ability of doctors in other departments
.
As
an infectious disease doctor, Director Hu Bijie also often teaches patients how to prevent infections
that may occur in daily life.
Hu Bijie encountered a patient with a fungal lung infection, and many antibiotics were ineffective, and later after comprehensive evaluation, it was considered that he was a fungal infection
.
Because the patient reported that the home had been flooded and the floor was moldy
.
Later, the patient pried open the floor of the home and found that it was covered with mold
underneath.
If the patient cannot find the source of the environmental infection, the infection
will occur again soon after the cure is returned.
He also treated a patient with pulmonary aspergillosis, which recurred after six months, and the lesions in the lungs increased
significantly.
"I said, you must have been exposed to moldy things recently, she finally remembered, the rice in the attic at home was moldy, reluctant to throw it away, washed and eaten, every time she opened the lid to scoop rice, mold spores would fly into the air and be inhaled
by her.
"
As an infectious disease doctor, Director Hu Bijie said that he is neither pessimistic nor optimistic
about the future.
"Optimism is not enough, after all, we are less and less of good antibiotics available, to say pessimistic, you think, in the past we were also pessimistic about tumors, now there are more and more treatments for tumors, and even become a chronic disease
.
"
