Gahunda ya Stewardship Programme (ASPs) yabaye inkingi yingenzi mugutezimbere imikoreshereze ya mikorobe, kunoza ubuvuzi bw’abarwayi, no kugabanya imiti igabanya ubukana (AMR) .Dore hano, twasuzumye ingaruka ASP igira ku ikoreshwa rya mikorobe na AMR muri Kolombiya.
Twateguye ubushakashatsi bwisubiraho kandi dupima imigendekere yo gukoresha antibiyotike na AMR mbere na nyuma yo gushyira mu bikorwa ASP mugihe cyimyaka 4 (amezi 24 mbere na 24 nyuma yo gushyira mubikorwa ASP) dukoresheje isesengura ryibihe byakurikiranye.
ASPs ishyirwa mubikorwa hashingiwe kubikoresho bya buri kigo kiboneka. Mbere yo gushyira mu bikorwa ASP, habaye inzira yo kongera antibiyotike yo gufata ingamba zose zatoranijwe za mikorobe. Nyuma yibyo, kugabanuka muri rusange kwa antibiyotike byagaragaye.Ertapenem na meropenem byagabanutse muri ibyumba byibitaro, mugihe ceftriaxone, cefepime, piperacillin / tazobactam, meropenem, na vancomycine yagabanutse mubice byitaweho cyane.Icyerekezo cyo kwiyongera kwa acapilline irwanya Staphylococcus aureus, ceftriaxone irwanya Escherichia coli, na meropenem irwanya Pereudoma. .
Mu bushakashatsi bwacu, twerekana ko ASP ari ingamba zingenzi mu guhangana n’iterabwoba rigaragara rya AMR kandi bigira ingaruka nziza ku kugabanuka kwa antibiyotike no kurwanya.
Kurwanya mikorobe (AMR) bifatwa nk’ibangamira ubuzima bw’isi yose [1, 2], bigatera abantu barenga 700.000 buri mwaka.Mu mwaka wa 2050, impfu zishobora kuba miliyoni 10 ku mwaka [3] kandi zishobora kwangiza rusange. ibicuruzwa byo mu gihugu imbere cyane cyane ibihugu biciriritse kandi biciriritse (LMICs) [4].
Imihindagurikire y’imiterere mikorobe n’isano iri hagati yo gukoresha nabi mikorobe na AMR bizwi mu myaka mirongo ishize. iterabwoba rigaragara rya AMR [6] .Mu myaka mike ishize, gahunda yo kwita ku micungire ya mikorobe (ASPs) yabaye inkingi yibanze mugutezimbere imikoreshereze ya mikorobe mu kunoza iyubahirizwa ry’amabwiriza ya mikorobe kandi bizwiho guteza imbere ubuvuzi bw’abarwayi mu gihe bigira ingaruka nziza kuri AMR [7, 8].
Ibihugu biciriritse kandi biciriritse mubusanzwe bifite umubare munini wa AMR bitewe no kubura ibizamini byihuse byo kwisuzumisha, imiti igabanya ubukana bwa virusi, ndetse no kugenzura epidemiologiya [9], bityo rero ingamba zishingiye kuri ASP nko guhugura kumurongo, gahunda zubujyanama, umurongo ngenderwaho wigihugu . politiki yubuzima rusange kugirango bakemure AMR [9].
Ubushakashatsi bwinshi bwibitaro by’abarwayi bari mu bitaro bwerekanye ko ASP ishobora kunoza iyubahirizwa ry’amabwiriza yo kuvura mikorobe kandi ikagabanya antibiyotike idakenewe, mu gihe igira ingaruka nziza ku gipimo cya AMR, indwara zandurira mu bitaro, ndetse n’ibisubizo by’abarwayi [8, 10, 11], 12]. Ibikorwa bifatika cyane birimo gusubiramo ibitekerezo no gutanga ibitekerezo, kubyemererwa, hamwe nibyifuzo byihariye byo kuvura [13] .Nubwo intsinzi ya ASP yasohotse muri Amerika y'Epfo, hari raporo nkeya ku ngaruka z’amavuriro, mikorobe, n’ubukungu by’ibi bikorwa [14,15,16,17,18].
Icyari kigamijwe muri ubu bushakashatsi kwari ugusuzuma ingaruka za ASP ku ikoreshwa rya antibiyotike na AMR mu bitaro bine bigoye cyane muri Kolombiya hakoreshejwe isesengura ry’ibihe.
Ubushakashatsi bwibanze ku mazu ane yo mu mijyi ibiri ya Kolombiya (Cali na Barranquilla) mu gihe cy'amezi 48 kuva 2009 kugeza 2012 (amezi 24 mbere y'amezi 24 nyuma yo gushyira mu bikorwa ASP) Yakorewe mu bitaro bigoye cyane (ibigo AD) .Ibiryo bya antibiyotike na meropenem-irwanya Acinetobacter baumannii (MEM-R Aba), ceftriaxone irwanya E. coli (CRO-R Eco), ertapenem irwanya Klebsiella pneumoniae (ETP-R Kpn), Indwara ya Ropenem Pseudomonas aeruginosa (MEM-R Pae) na MEM-R Pae) yapimwe na oxacillin irwanya Staphylococcus aureus (OXA-R Sau) yapimwe mugihe cyubushakashatsi. Isuzuma ryibanze rya ASP ryakozwe mugitangira cyinyigisho, hakurikiraho gukurikirana iterambere rya ASP mumezi atandatu ari imbere ukoresheje Indicative Compound Antimicrobial (ICATB) Ironderero rya Antibicrobial Stewardship [19] .Barabaruwe amanota ya ICATB.Icyumba rusange n’ibice byita ku barwayi (ICUs) byashyizwe mu isesengura. Ibyumba byihutirwa n’ubuvuzi bw’abana ntibyashyizwe mu bushakashatsi.
Ibintu bisanzwe biranga ASP yinzego zirimo: (1) Amatsinda atandukanye ya ASP: abaganga bindwara zandura, abafarumasiye, mikorobe, abashinzwe abaforomo, komite zishinzwe kurwanya no gukumira;.(3) ubwumvikane hagati yinzobere zitandukanye kumabwiriza ya mikorobe nyuma yo kuganira na mbere yo kuyashyira mubikorwa;. yasuzumye antibiyotike kandi itanga ibitekerezo bitaziguye kandi bigasaba gukomeza, guhindura, guhindura cyangwa guhagarika imiti;
Ibisobanuro bya buri munsi (DDDs) bishingiye kuri sisitemu yo kubara umuryango mpuzamahanga wita ku buzima (OMS) mu gupima antibiyotike.DDD ku buriri-iminsi 100 mbere na nyuma yo guterwa na ceftriaxone, cefepime, piperacillin / tazobactam, ertapenem, meropenem, na vancomycine byandikwa buri kwezi kuri buri bitaro. Ibipimo byisi ku bitaro byose bitangwa buri kwezi mugihe cyo gusuzuma.
Kugirango bapime indwara ya MEM-R Aba, CRO-R Eco, ETP-R Kpn, MEM-R Pae, na OXA-R Sau, umubare w'abarwayi bafite indwara zanduye mu bitaro (ukurikije CDC n'umuco wa mikorobe-nziza ya prophylaxis [CDC] Ubuziranenge bwa Sisitemu) igabanijwe numubare winjira mubitaro (mumezi 6) × 1000 byakira abarwayi. Gusa umurwayi umwe wihariye wubwoko bumwe washyizwemo umurwayi.Ku rundi ruhande, nta mpinduka nini zigeze zihinduka mubisuku byamaboko , ingamba zo kwigunga, ingamba zo gusukura no kwanduza indwara mu bitaro bine.Mu gihe cyo gusuzuma, protocole yashyizwe mu bikorwa na komite ishinzwe kurwanya no gukumira indwara ntiyahindutse.
Amabwiriza ngenderwaho ya Clinical and Laboratory Standard Institute (CLSI) yakoreshejwe mu kumenya imigendekere yo guhangana, hitawe ku gutandukanya ibyiyumvo bya buri bwigunge mu gihe cyo kwiga, kugira ngo ibisubizo bigereranye.
Guhagarika ibihe byakurikiranye kugirango ugereranye imikoreshereze ya antibiyotike ya DDD ku isi yose hamwe n’amezi atandatu yo guhurira hamwe kwa MEM-R Aba, CRO-R Eco, ETP-R Kpn, MEM-R Pae, na OXA-R Sau mu bitaro by’ibitaro no mu bitaro byita ku barwayi bakomeye. .Ibiryo bya antibiyotike, coefficient hamwe nindwara zanduye mbere yo gutabarwa, inzira mbere na nyuma yo gutabara, hamwe nimpinduka murwego rwose nyuma yo gutabarwa byanditswe. Ibisobanuro bikurikira birakoreshwa: β0 ni ihoraho, β1 ni coefficente yuburyo bwambere bwo gutabara. .
Ibitaro bine byashyizwemo mugihe cyamezi 48 yo gukurikirana;ibiranga bigaragara mu mbonerahamwe ya 1.
Nubwo gahunda zose zari ziyobowe naba epidemiologiste cyangwa abaganga b’indwara zandura (Imbonerahamwe 2), ikwirakwizwa ry’abakozi kuri ASP ryatandukanye mu bitaro.Ikigereranyo cyo hagati ya ASP cyari $ 1,143 ku buriri 100. Inzego D na B zakoresheje igihe kinini cyo gutabara ASP, gukora amasaha 122.93 na 120.67 ku buriri 100 buri kwezi, kimwe.Abaganga b’indwara zandura, epidemiologiste naba farumasi y’ibitaro muri ibyo bigo byombi bafite amasaha menshi. bigo kubera abahanga benshi bitanze.
Mbere yo gushyira mu bikorwa ASP, ibigo bine byari byiganjemo antibiyotike yagutse (ceftriaxone, cefepime, piperacillin / tazobactam, ertapenem, meropenem, na vancomycine) muri rusange muri ICU.Hariho imyiyerekano igenda ikoreshwa (Ishusho 1) .Gukurikiza ishyirwa mubikorwa rya ASP, gukoresha antibiotique byagabanutse mubigo;ikigo B (45%) cyaragabanutse cyane, gikurikirwa n’ibigo A (29%), D (28%), na C (20%) igihe cyo kwiga ugereranije nigihe cya gatatu nyuma yo gushyira mubikorwa (p <0.001) .Nyuma yo gushyira mubikorwa ASP, gukoresha meropenem, cefepime, naceftriaxoneyagabanutse cyane kugera kuri 49%, 16%, na 7% mubigo C, D, na B, (p <0.001) .Gukoresha vancomycine, piperacillin / tazobactam, na ertapenem ntabwo byari bitandukanye mubibare. Kubireba ikigo A, kugabanya gukoresha meropenem, piperacillin / tazobactam, naceftriaxonebyagaragaye mu mwaka wa mbere nyuma yo gushyira mu bikorwa ASP, nubwo imyitwarire itagaragaje ko igabanuka ryumwaka ukurikira (p> 0.05).
Inzira ya DDD yo gukoresha antibiyotike yagutse (ceftriaxone, cefepime, piperacillin / tazobactam, ertapenem, meropenem, na vancomycine) muri ICU no muri rusange.
Icyerekezo gikomeye cyo kuzamuka kwagaragaye muri antibiyotike zose zasuzumwe mbere yuko ASP ishyirwa mubikorwa by’ibitaro.Imikoreshereze ya ertapenem na meropenem yagabanutse ku buryo bugaragara nyuma yuko ASP ishyizwe mu bikorwa.Nyamara, nta kugabanuka gukomeye kw’imibare kwagaragaye mu kunywa izindi antibiyotike (Imbonerahamwe 3 ) .Ku bijyanye na ICU, mbere yo gushyira mu bikorwa ASP, hagaragaye icyerekezo gikomeye cyo kuzamuka kuri antibiyotike zose zasuzumwe, usibye ertapenem na vancomycine. Ukurikije ishyirwa mu bikorwa rya ASP, gukoresha ceftriaxone, cefepime, piperacillin / tazobactam, meropenem, na vancomycine byagabanutse.
Kubijyanye na bagiteri irwanya multidrug, hari imibare igaragara cyane muri OXA-R Sau, MEM-R Pae, na CRO-R Eco mbere yo gushyira mu bikorwa ASP. Ibinyuranye, inzira ya ETP-R Kpn na MEM-R Aba ntabwo bari bafite imibare ihambaye.Icyerekezo cya CRO-R Eco, MEM-R Pae, na OXA-R Sau cyahindutse nyuma yuko ASP ishyizwe mubikorwa, mugihe inzira ya MEM-R Aba na ETP-R Kpn itari ifite imibare (Imbonerahamwe 4 ).
Ishyirwa mu bikorwa rya ASP no gukoresha neza antibiyotike ni ngombwa mu guhashya AMR [8, 21] .Mu bushakashatsi bwacu, twabonye ko hagabanywa ikoreshwa rya mikorobe zimwe na zimwe muri bitatu muri bine byize.Ingamba zinyuranye zashyizwe mu bikorwa n’ibitaro zishobora kugira uruhare mu gutsinda. y'ibi bitaro bya ASP. Kuba ASP igizwe n'itsinda rinyuranye ry'inzobere ni ingenzi kuko bashinzwe gusabana, gushyira mu bikorwa, no gupima kubahiriza amabwiriza ya mikorobe. Izindi ngamba zatsinzwe zirimo kuganira ku mabwiriza ya antibacterial hamwe no kwandika abahanga mbere yo kuyashyira mu bikorwa. ASP no kumenyekanisha ibikoresho byo gukurikirana antibiyotike ikoreshwa, ishobora gufasha kubika ibisobanuro ku mpinduka zose zanduza antibacterial.
Ibigo nderabuzima bishyira mu bikorwa ASP bigomba guhuza ibikorwa byabo n’abakozi bahari ndetse n’inkunga y’imishahara y’ikipe ishinzwe igisonga cya mikorobe. Ubunararibonye bwacu burasa n’ubwavuzwe na Perozziello na bagenzi be mu bitaro by’Ubufaransa [22] .Ikindi kintu cyingenzi cyari inkunga y’ibitaro. ubuyobozi mubigo byubushakashatsi, byoroheje imiyoborere yitsinda ryakazi rya ASP.Ikindi kandi, kugenera igihe cyakazi inzobere zindwara zandura, abafarumasiye mubitaro, abaganga rusange naba nkeragutabara nikintu cyingenzi mugushira mubikorwa ASP neza [23] .Mu bigo B na C, ubwitange bwa GPs bwigihe kinini cyakazi mugushyira mubikorwa ASP bishobora kuba byaragize uruhare mukubahiriza amabwiriza ya mikorobe, nkayatangajwe na Goff na bagenzi be [24] .Ku kigo C, umuforomo mukuru yari ashinzwe gukurikirana iyubahirizwa rya mikorobe kandi koresha no gutanga ibitekerezo bya buri munsi kubaganga.Iyo habaye disiki yanduye cyangwa imwe gusakoroshya inzobere mu buriri 800, ibisubizo byiza byabonetse hamwe nabaforomo bayobowe na ASP byari bisa nubushakashatsi bwashyizwe ahagaragara na Monsees [25].
Nyuma y’ishyirwa mu bikorwa rya ASP mu bigo rusange by’ibigo nderabuzima bine muri Kolombiya, byagaragaye ko igabanuka ry’imiti ya antibiyotike yose yize ryagaragaye, ariko imibare ifite akamaro kanini kuri karbapenem. Gukoresha karbapenem mbere byajyanye no kwangiriza ingwate bihitamo bacteri zirwanya imiti myinshi [26,27,28,29] .Nuko rero, kugabanya ibyo ukoresha bizagira ingaruka ku ndwara y’ibimera birwanya ibiyobyabwenge mu bitaro ndetse no kuzigama amafaranga.
Muri ubu bushakashatsi, ishyirwa mu bikorwa rya ASP ryerekanye ko igabanuka ry’indwara ya CRO-R Eco, OXA-R Sau, MEM-R Pae, na MEM-R Aba. Ubundi bushakashatsi bwakorewe muri Kolombiya bwerekanye kandi ko igabanuka rya beta yagutse -lactamase (ESBL) -ibyara E. coli no kongera ubukana bwa cephalosporine yo mu gisekuru cya gatatu [15, 16] .Abanyeshuri bavuze kandi ko kugabanuka kwa MEM-R Pae nyuma y’ubuyobozi bwa ASP [16, 18] hamwe na antibiotike zindi nka piperacillin / tazobactam na cefepime [15, 16] .Ubushakashatsi bwakozwe ntibushobora kwerekana ko ibisubizo birwanya bagiteri biterwa ahanini no gushyira mu bikorwa ASP.Ibindi bintu bigira uruhare mu kugabanya bagiteri zirwanya bishobora kuba bikubiyemo kubahiriza isuku y'intoki. no gukora isuku no kwanduza, hamwe no kumenyekanisha muri rusange AMR, ishobora cyangwa idahuye nimyitwarire yubu bushakashatsi.
Agaciro k'ibitaro ASPs birashobora gutandukana cyane mubihugu. Ariko, mubisubiramo buri gihe, Dilip nabandi.yerekanye ko nyuma yo gushyira mu bikorwa ASP, impuzandengo yo kuzigama yatandukanijwe nubunini bwibitaro nakarere. Ikigereranyo cyo kuzigama amafaranga yo muri Amerika cyari $ 732 kumurwayi (intera 2.50-2640), hamwe nuburyo bumwe mubushakashatsi bwiburayi.Mu bushakashatsi bwacu, impuzandengo ya buri kwezi yibintu bihenze cyane ni $ 2,158 kumuriri 100 namasaha 122.93 kumurimo kuburiri 100 kukwezi kubera igihe cyashowe nabashinzwe ubuzima.
Twese tuzi ko ubushakashatsi bwakozwe kuri ASP bufite aho bugarukira.Ibihinduka byapimwe nkibisubizo byiza byamavuriro cyangwa kugabanuka kwigihe kirekire mukurwanya bagiteri byari bigoye guhuza ningamba za ASP zikoreshwa, igice kubera igihe gito cyo gupima kuva buri ASP yari byashyizwe mu bikorwa.Kurundi ruhande, impinduka muri epidemiologiya ya AMR yaho mumyaka irashobora kugira ingaruka kubisubizo byubushakashatsi ubwo aribwo bwose, isesengura ryibarurishamibare ryananiwe gufata ingaruka zabaye mbere yo gutabara ASP [31].
Mu bushakashatsi bwacu, icyakora, twakoresheje isesengura ryigihe cyuruhererekane hamwe nurwego hamwe nicyerekezo mugice kibanziriza intervention nkigenzura ryigice cya nyuma yo gutabarana, gitanga igishushanyo mbonera cyemewe cyo gupima ingaruka zokwitabwaho.Kubera ko kuruhuka mubihe byakurikiranye ingingo zihariye mugihe ibikorwa byashyizwe mubikorwa, umwanzuro wuko intervention igira ingaruka itaziguye mubisubizo nyuma yigihe cyo gutabara ishimangirwa no kuba hari itsinda rishinzwe kugenzura ritigeze rigira uruhare, bityo, kuva mbere yo gutabara kugeza kuri igihe cya nyuma yo gutabarwa nta gihinduka.Ikindi kandi, ibishushanyo mbonera byateganijwe birashobora kugenzura ingaruka zijyanye nigihe cyo kwitiranya ibihe nkibihe [32, 33] .Gusuzuma ASP kugirango isesengura ryibihe byahagaritswe birakenewe cyane kubera ko hakenewe ingamba zisanzwe, ingamba zagezweho , hamwe ningamba zisanzwe, hamwe no gukenera ibihe byigihe kugirango birusheho gukomera mugusuzuma ASP.Nubwo ibyiza byose byubu buryo,hari aho bigarukira.Umubare wokureba, guhuza amakuru mbere na nyuma yo gutabarana, hamwe na autocorrelation yamakuru yose bigira ingaruka kumbaraga zubushakashatsi. Kubwibyo, niba imibare igabanuka cyane mukoresha antibiyotike no kugabanuka kwa bagiteri. biratangazwa mugihe, icyitegererezo cyibarurishamibare ntabwo kitwemerera kumenya imwe mubikorwa byinshi byashyizwe mubikorwa mugihe cya ASP nibyiza cyane kuko politiki ya ASP yose ishyirwa mubikorwa icyarimwe.
Igisonga cya antibicrobial ni ingenzi mugukemura ibibazo bya AMR bigenda bigaragara.Isuzuma rya ASP riragenda rivugwa mubitabo, ariko inenge yuburyo bukoreshwa mugushushanya, gusesengura, no gutanga raporo kubyo bikorwa bibangamira gusobanura no gushyira mubikorwa byinshi mubikorwa byatsinzwe.Nubwo umubare munini munini ASPs yakuze vuba mumahanga, byagoye LMIC kwerekana intsinzi yizo gahunda.Nubwo hari aho bigarukira, ubushakashatsi bwimbitse bwo mu rwego rwo hejuru burashobora kuba ingirakamaro mu gusesengura ibikorwa bya ASP. Mu bushakashatsi bwacu ugereranije na ASP ya ibitaro bine, twashoboye kwerekana ko bishoboka gushyira mubikorwa gahunda nkiyi mubitaro bya LMIC.Turakomeza kandi kwerekana ko ASP igira uruhare runini mukugabanya ikoreshwa rya antibiotique no kurwanya.Twemera ko, nka politiki yubuzima rusange, ASPs ugomba kwakira inkunga yigihugu igenga, uzirikana ko nabo bagize igice cyanjyeibintu bifatika byo kwemerera ibitaro bijyanye n'umutekano w'abarwayi.
Igihe cyo kohereza: Gicurasi-18-2022