Iinkqubo ze-Antimicrobial Stewardship Programs (ASPs) ziye zaba yintsika ebalulekileyo yokuphucula ukusetyenziswa kwe-antimicrobial, ukuphucula ukunakekelwa kwesigulane, kunye nokunciphisa ukuchasana kwe-antimicrobial (AMR) .Apha, sivavanye impembelelo ye-ASP ekusebenziseni i-antimicrobial kunye ne-AMR eColombia.
Siye sayila uphononongo lokujonga i-retrospective kunye nokulinganisa iindlela zokusetyenziswa kwe-antibiotics kunye ne-AMR ngaphambi nangemva kokuphunyezwa kwe-ASP kwixesha le-4 (iinyanga ezingama-24 ngaphambi kunye neenyanga ze-24 emva kokuphunyezwa kwe-ASP) kusetyenziswa uhlalutyo oluphazamisekileyo lwexesha.
I-ASPs iphunyezwa ngokusekelwe kwizibonelelo ezifumanekayo zeziko ngalinye.Ngaphambi kokuphunyezwa kwe-ASP, kwakukho umkhwa wokunyuka kokusetyenziswa kwe-antibiotic kuyo yonke imilinganiselo ekhethiweyo ye-antimicrobials.Emva koko, ukuhla ngokubanzi kokusetyenziswa kwe-antibiotic kwabonwa.Ukusetyenziswa kwe-Ertapenem kunye ne-meropenem yehla Iiwadi zesibhedlele, ngelixa i-ceftriaxone, i-cefepime, i-piperacillin/tazobactam, i-meropenem, kunye ne-vancomycin yehla kwiiyunithi zokhathalelo olunzima.Umkhwa wokunyuka kwe-oxacillin-resistant Staphylococcus aureus, i-ceftriaxone-resistant Escherichia coli, kunye ne-meropenseuresis-resistant ye-meropenseuresisSP emva kokuphunyezwa kwe-meropenseuresis. .
Kuphononongo lwethu, sibonisa ukuba i-ASP sisicwangciso esiphambili ekujonganeni nosongelo oluvelayo lwe-AMR kwaye lunempembelelo entle ekuphelisweni kwe-antibiotic kunye nokuchasana.
Ukunganyangeki kweAntimicrobial (AMR) ithathwa njengesoyikiso kwihlabathi jikelele kwimpilo yoluntu [1, 2], ebangela ukufa okungaphezulu kwama-700,000 ngonyaka.Ngo-2050, inani lokufa linokuba phezulu njenge-10 yezigidi ngonyaka [3] kwaye inokonakalisa i-gross. imveliso yasekhaya yamazwe, ngakumbi amazwe anengeniso ephantsi naphakathi (LMICs) [4].
Ukuguquguquka okuphezulu kwe-microorganisms kunye nobudlelwane phakathi kokusetyenziswa kakubi kwe-antimicrobial kunye ne-AMR yaziwa amashumi eminyaka [5].Ngo-1996, uMcGowan kunye noGerding babiza "ubuqhetseba bokusetyenziswa kwe-antimicrobial," kubandakanywa ukulungiswa kokukhethwa kwe-antimicrobial, idosi kunye nobude bonyango, ukujongana. isoyikiso esikhulayo se-AMR [6] .Kwiminyaka embalwa edlulileyo, iinkqubo ze-antimicrobial stewardship program (ASPs) ziye zaba yintsika esisiseko ekuphuculeni ukusetyenziswa kwe-antimicrobial ngokuphucula ukuthotyelwa kwemigaqo ye-antimicrobial kwaye ziyaziwa ngokuphucula ukhathalelo lwesigulane ngelixa kunempembelelo efanelekileyo kwi-AMR. [7, 8].
Amazwe anengeniso ephantsi kunye nephakathi anesiqhelo esiphezulu se-AMR ngenxa yokunqongophala kovavanyo olukhawulezayo lokuxilonga, i-antimicrobial yesizukulwana sokugqibela, kunye nokuhlolwa kwe-epidemiological surveillance [9], ngoko ke izicwangciso ezijoliswe kwi-ASP ezifana noqeqesho lwe-intanethi, iinkqubo zokufundisa, izikhokelo zelizwe. , kunye Ukusetyenziswa kweqonga leendaba zoluntu kuye kwaba yinto ephambili [8] .Nangona kunjalo, ukudityaniswa kwezi ASP kungumngeni ngenxa yokungabikho rhoqo kwabasebenzi bezempilo abaqeqeshwe kwi-antimicrobial stewardship, ukungabikho kweerekhodi zonyango lwe-elektroniki, kunye nokungabikho kwelizwe lonke. umgaqo-nkqubo wezempilo yoluntu ukujongana ne-AMR [9].
Izifundo ezininzi zezibhedlele zezigulane ezibhedlele zibonise ukuba i-ASP inokuphucula ukuthotyelwa kwezikhokelo zonyango lwe-antimicrobial kunye nokunciphisa ukusetyenziswa kwe-antibiotic engadingekile, ngelixa kunemiphumo emihle kumazinga e-AMR, izifo ezifunyenwe esibhedlele, kunye neziphumo zesigulane [8, 10, 11], 12]. Olona ngenelelo lusebenzayo lubandakanya ukuphononongwa okuzayo kunye nengxelo, ukugunyazwa kwangaphambili, kunye neengcebiso zonyango ezichanekileyo [13] .Nangona impumelelo ye-ASP ishicilelwe kwiLatin America, kukho iingxelo ezimbalwa malunga nefuthe leklinikhi, i-microbiological, kunye nezoqoqosho kula mangenelelo. [14,15,16,17,18].
Injongo yolu phononongo yayikukuvavanya impembelelo ye-ASP ekusebenziseni i-antibiotics kunye ne-AMR kwizibhedlele ezine ezinzima kakhulu eColombia zisebenzisa uhlalutyo lwexesha eliphazamisekileyo.
Uphononongo olwenziwayo lokuqwalasela amakhaya amane kwiidolophu ezimbini zaseColombia (iCali kunye neBarranquilla) kwixesha leenyanga ze-48 ukusuka kwi-2009 ukuya kwi-2012 (iinyanga ze-24 ngaphambi kunye neenyanga ze-24 emva kokuphunyezwa kwe-ASP) Yenziwa kwizibhedlele ezinzima kakhulu (amaziko AD) . meropenem-resistant Acinetobacter baumannii (MEM-R Aba), ceftriaxone-resistant E. coli (CRO-R Eco), ertapenem-resistant Klebsiella pneumoniae (ETP-R Kpn), Izehlo zeRopenem Pseudomonas aeruginosa (ME) kunye ne-ME I-oxacillin-resistant Staphylococcus aureus (OXA-R Sau) yalinganiswa ngexesha lophando.Uvavanyo lwesiseko lwe-ASP lwenziwa ekuqaleni kwexesha lokufunda, lulandelwa ngokubeka iliso kwinkqubela phambili ye-ASP kwiinyanga ezintandathu ezizayo kusetyenziswa i-Indicative Compound Antimicrobial (ICATB) I-Antimicrobial Stewardship Index [19] .Umyinge wamanqaku e-ICATB abalwa.Iiwadi eziqhelekileyo kunye neeyunithi zokunyamekela kakhulu (ICUs) zifakwe kuhlalutyo.Amagumbi angxamisekileyo kunye neewadi zabantwana zazingabandakanywa kwisifundo.
Iimpawu eziqhelekileyo ze-ASP zamaziko athatha inxaxheba zibandakanya: (1) Amaqela e-ASP ahlukeneyo: oogqirha bezifo ezithathelwanayo, iikhemisti, i-microbiologists, abaphathi bomongikazi, iikomiti zokulawula ukusuleleka kunye nokuthintela;(2) Izikhokelo ze-Antimicrobial kwizifo ezixhaphakileyo, ezihlaziywa liqela le-ASP kwaye zisekelwe kwi-epidemiology yeziko;(3) ukuvumelana phakathi kweengcali ezahlukeneyo kwizikhokelo ze-antimicrobial emva kwengxoxo nangaphambi kokuphunyezwa;(4) uphicotho olulindelekileyo kunye nengxelo sisicwangciso salo lonke kodwa elinye iziko (iziko D liphumeze ukumisela okuthintelweyo (5) Emva kokuba unyango lwe-antibiotic luqalisile, iqela le-ASP (ikakhulukazi yi-GP ingxelo kugqirha wezifo ezithathelwanayo) liphonononga ummiselo okhethiweyo. i-antibiotic eqinisekisiweyo kwaye inikezela ngengxelo echanekileyo kunye neengcebiso zokuqhubeka, ukulungelelanisa, ukuguqula okanye ukuyeka unyango; (6) rhoqo (zonke iinyanga ze-4-6) ukungenelela kwezemfundo ukukhumbuza oogqirha ngezikhokelo ze-antimicrobial; (7) inkxaso yolawulo lwesibhedlele sokungenelela kweqela le-ASM.
Iidosi zemihla ngemihla ezichaziweyo (DDDs) ezisekelwe kwinkqubo yokubala yoMbutho wezeMpilo weHlabathi (i-WHO) zisetyenziselwe ukulinganisa ukusetyenziswa kwamayeza okubulala iintsholongwane.I-DDD nganye ngeentsuku ze-100 zokulala ngaphambi nangemva kokungenelela kunye ne-ceftriaxone, i-cefepime, i-piperacillin / tazobactam, i-ertapenem, i-meropenem, kunye ne-vancomycin yabhalwa ngenyanga kwisibhedlele ngasinye.
Ukulinganisa iziganeko ze-MEM-R Aba, i-CRO-R Eco, i-ETP-R Kpn, i-MEM-R Pae, kunye ne-OXA-R Sau, inani lezigulane ezinezifo ezifunyenwe esibhedlele (ngokweCDC kunye ne-microbial culture-positive prophylaxis [CDC] IMigangatho yeNkqubo yokuHlola) yahlulwe ngenani lokungeniswa kwisibhedlele ngasinye (kwiinyanga ze-6) × izigulane ze-1000 zokungeniswa kwezigulane.Inye kuphela i-isolate yohlobo olufanayo ifakwe kwisigulane ngasinye.Ngakolunye uhlangothi, akukho tshintsho olukhulu ekucocekeni kwesandla. , izilumkiso zokuzihlukanisa, ukucocwa kunye nezicwangciso zokubulala iintsholongwane kwizibhedlele ezine.Ngexesha lokuvavanya, i-protocol ephunyezwe yiKomiti yoLawulo lwe-Infection and Prevention yahlala ingatshintshi.
Izikhokelo ze-2009 kunye ne-2010 ye-Clinical and Laboratory Standards Institute (CLSI) zisetyenziselwe ukufumanisa iindlela zokuxhathisa, kuthathelwa ingqalelo i-sensitivity breakpoints ye-isolate nganye ngexesha lokufunda, ukuqinisekisa ukuthelekiswa kweziphumo.
Uphononongo lwexesha eliphazanyisiweyo lokuthelekisa ukusetyenziswa kwe-DDD yenyanga nenyanga ye-antibiotics kunye nenyanga ezintandathu ezehlo ze-MEM-R Aba, i-CRO-R Eco, i-ETP-R Kpn, i-MEM-R Pae, kunye ne-OXA-R Sau kwiiwadi zesibhedlele kunye neeyunithi zokhathalelo olunzulu. .Ukusetyenziswa kwe-Antibiotic, i-coefficients kunye neziganeko zokusuleleka kwangaphambi kokungenelela, iintsingiselo ngaphambi nangemva kokungenelela, kunye noshintsho kumanqanaba apheleleyo emva kokungenelela kurekhodiwe.Iinkcazo ezilandelayo zisetyenziswa: β0 isigxina, i-β1 yi-coefficient yendlela yokungenelela kwangaphambili. , i-β2 yinguqu yenguqu, kwaye i-β3 yindlela yokungenelela emva kokungenelela [20]. Uhlalutyo lwezibalo lwenziwa kwi-STATA® 15th Edition. I-p-value <0.05 ithathwa njengebalulekileyo.
Izibhedlele ezine zifakwe ngexesha lokulandelwa kweenyanga ze-48;iimpawu zabo ziboniswe kwiThebhile 1.
Nangona zonke iinkqubo zikhokelwa yi-epidemiologists okanye oogqirha bezifo ezithathelwanayo (Itheyibhile 2), ukuhanjiswa kwemithombo yoluntu kwi-ASPs kwahluka kwizibhedlele.Ixabiso eliqhelekileyo le-ASP laliyi-1,143 yeebhedi ze-100. Amaziko e-D kunye ne-B achitha ixesha elide kakhulu lokungenelela kwe-ASP, ukusebenza 122.93 kunye 120.67 iiyure nganye 100 iibhedi ngenyanga, ngokulandelanayo.Oogqirha izifo ezosulelayo, epidemiologists kunye noosokhemesti esibhedlele kuwo omabini amaziko ngokwembali zineeyure eziphezulu.Institution D's ASP ilinganiselwa kwi-2,158 yeebhedi ezili-100 ngenyanga, kwaye yayiyeyona nto ibiza kakhulu phakathi kwe-4 amaziko ngenxa yeengcali ezizinikele ngakumbi.
Ngaphambi kokuphunyezwa kwe-ASP, amaziko amane ayenowona nyango luphezulu lwe-antibiotics (ceftriaxone, cefepime, piperacillin/tazobactam, ertapenem, meropenem, kunye ne-vancomycin) kwiiwadi eziqhelekileyo kunye nee-ICU.Kukho ukunyuka kokusetyenziswa (Umfanekiso 1) .Emva kokuphunyezwa kwe-ASP, ukusetyenziswa kwe-antibiotic kwehle kuwo wonke amaziko;Iziko B (45%) lehle kakhulu, lilandelwa ngamaziko A (29%), D (28%), kunye no-C (20%).Iziko C liyirhoxisile inkqubo yokusetyenziswa kwamayeza okubulala iintsholongwane, amanqanaba angaphantsi nakancinane kunakuqala. ixesha lokufunda xa kuthelekiswa nexesha lesithathu emva kokuphunyezwa (p <0.001) .Emva kokuphunyezwa kwe-ASP, ukusetyenziswa kwe-meropenem, i-cefepime, kunyeceftriaxoneyehle kakhulu ukuya kwi-49%, i-16%, kunye ne-7% kumaziko e-C, D, kunye no-B, ngokulandelanayo (p <0.001). Ukusetyenziswa kwe-vancomycin, i-piperacillin / tazobactam, kunye ne-ertapenem ayizange ihluke ngokwezibalo. Kwimeko yesibonelelo A, ukunciphisa ukusetyenziswa kwe-meropenem, i-piperacillin / tazobactam, kunyeceftriaxonekwaphawulwa kunyaka wokuqala emva kokuphunyezwa kwe-ASP, nangona ukuziphatha kungakhange kubonise nakuphi na ukwehla kwendlela kunyaka olandelayo (p> 0.05).
Iimpawu ze-DDD ekusetyenzisweni kwe-antibiotics ebanzi (i-ceftriaxone, i-cefepime, i-piperacillin / tazobactam, i-ertapenem, i-meropenem, kunye ne-vancomycin) kwi-ICU kunye neewadi eziqhelekileyo
Ukunyuka okubalulekileyo kwezibalo kwabonwa kuwo onke ama-antibiotics ahlolwe ngaphambi kokuba i-ASP iphunyezwe kwiiwadi zesibhedlele.Ukusetyenziswa kwe-ertapenem kunye ne-meropenem kwehle ngokwezibalo emva kokuba i-ASP iphunyezwe.Nangona kunjalo, akukho kuncipha kwezibalo kubonwe ekusetyenzisweni kwamanye amayeza okubulala iintsholongwane (Itheyibhile 3) .Ngokumalunga ne-ICU, ngaphambi kokuphunyezwa kwe-ASP, ukunyuka okubalulekileyo ngokwezibalo kwabonwa kuzo zonke izibulala-ntsholongwane ezivavanyiweyo, ngaphandle kwe-ertapenem kunye ne-vancomycin.Ukulandela ukuphunyezwa kwe-ASP, ukusetyenziswa kwe-ceftriaxone, i-cefepime, i-piperacillin/tazobactam, i-meropenem, kunye ne-vancomycin yehla.
Ngokubhekiselele kwiibhaktheriya ezixhathisa amayeza amaninzi, kwakukho i-statistically ephawulekayo indlela yokunyuka kwe-OXA-R Sau, i-MEM-R Pae, kunye ne-CRO-R Eco ngaphambi kokuphunyezwa kwe-ASPs.Ngokwahlukileyo, iindlela ze-ETP-R Kpn kunye ne-MEM-R I-Aba yayingabalulekanga ngokwezibalo.Intsingiselo ye-CRO-R Eco, i-MEM-R Pae, kunye ne-OXA-R Sau yatshintsha emva kokuba i-ASP iphunyeziwe, ngelixa iindlela ze-MEM-R Aba kunye ne-ETP-R Kpn zazingabalulekanga ngokwezibalo (Itheyibhile 4 ).
Ukuphunyezwa kwe-ASP kunye nokusetyenziswa ngokufanelekileyo kwe-antibiotics kubalulekile ukucinezela i-AMR [8, 21].Kuphononongo lwethu, siye sabona ukunciphisa ukusetyenziswa kwee-antimicrobials ezithile kumaziko amathathu afundwayo.Izicwangciso ezininzi eziphunyeziweyo zizibhedlele zinokufaka isandla kwimpumelelo. kwezi zibhedlele ze-ASPs.Inyaniso yokuba i-ASP yenziwe liqela leqela leengcali zibalulekile njengoko zinoxanduva lokuhlalisana, ukuphumeza, kunye nokulinganisa ukuthotyelwa kwezikhokelo ze-antimicrobial.Ezinye izicwangciso eziyimpumelelo ziquka ukuxoxa ngezikhokelo ze-antibacterial kunye neengcali ezichazayo ngaphambi kokuba ziphunyezwe. I-ASP kunye nokwazisa izixhobo zokubeka esweni ukusetyenziswa kwe-antibiotic, enokukunceda ukugcina iithebhu kulo naluphi na utshintsho kwi-antibacterial prescribing.
Izibonelelo zempilo eziphunyezwayo ze-ASP kufuneka zilungelelanise ukungenelela kwazo kwimithombo yoluntu ekhoyo kunye nenkxaso yokuhlawula iqela le-antimicrobial stewardship team.Amava ethu afana nalawo achazwe nguPerozziello kunye noogxa kwisibhedlele saseFransi [22].Enye into ephambili yayiyinkxaso yesibhedlele. ulawulo kwiziko lophando, eliququzelela ukulawulwa kweqela lomsebenzi we-ASP.Ngaphezu koko, ukwaba ixesha lomsebenzi kwiingcali zezifo ezithathelwanayo, oosokhemesti besibhedlele, oogqirha abaqhelekileyo kunye nee-paramedics yinto ebalulekileyo yokuphunyezwa ngempumelelo kwe-ASP [23].Kumaziko B. kunye ne-C, i-GPs 'ukuzinikela kwexesha elibalulekileyo lomsebenzi ekuphunyezweni kwe-ASP inokuba negalelo ekuthotyelweni kwabo okuphezulu kunye nezikhokelo ze-antimicrobial, ezifana nengxelo kaGoff kunye noogxa [24] .Kwiziko C, umongikazi oyintloko wayejongene nokubeka iliso ukuthotyelwa kwe-antimicrobial kunye ne-antimicrobial. sebenzisa kunye nokubonelela ngengxelo yemihla ngemihla kumagqirha.Xa kwakukho ezimbalwa okanye enye i-dis eyosulelayolula ingcali kwiibhedi ze-800, iziphumo ezibalaseleyo ezifunyenwe nge-ASP eqhutywa ngumongikazi zifana nezo zophononongo olupapashwe nguMonses [25].
Ukulandela ukuphunyezwa kwe-ASP kwiiwadi eziqhelekileyo zeendawo ezine zokunakekelwa kwezempilo eColombia, ukuthotywa kokunciphisa ukusetyenziswa kwazo zonke ii-antibiotics ezifundwe kwabonwa, kodwa kubaluleke kakhulu kwi-carbapenems. iibhaktheriya ezininzi ezinganyangekiyo ngamachiza [26,27,28,29] .Ngoko ke, ukunciphisa ukusetyenziswa kwayo kuya kuba nefuthe kwiziganeko zezityalo ezinganyangekiyo ngamachiza kwizibhedlele kunye nokugcinwa kweendleko.
Kulo pho nonongo, ukuphunyezwa kwe-ASP kubonise ukwehla kwesiganeko se-CRO-R Eco, i-OXA-R Sau, i-MEM-R Pae, kunye ne-MEM-R Aba.Olunye uphando eColombia luye lwabonisa ukunciphisa i-beta eyandisiweyo. -i-lactamase (ESBL) -ukuvelisa i-E. coli kunye nokwanda kokuchasana kwi-cephalosporins yesizukulwana sesithathu [15, 16].Izifundo ziye zabika ukuncipha kwesiganeko se-MEM-R Pae emva kokulawulwa kwe-ASP [16, 18] kunye nezinye ii-antibiotics. ezifana ne-piperacillin / tazobactam kunye ne-cefepime [15, 16].Uyilo lwesi sifundo alukwazi ukubonisa ukuba iziphumo zokuxhatshazwa kwebhaktheriya zibangelwa ngokupheleleyo ekuphunyezweni kwe-ASP.Ezinye izinto ezichaphazela ukunciphisa iibhaktheriya ezixhathisayo zingabandakanya ukunyuka kokuthotyelwa kwezandla. kunye nokucoca kunye nezenzo zokubulala iintsholongwane, kunye nokwazisa ngokubanzi kwe-AMR, enokuthi ihambelane okanye ingahambelani nokuqhutywa kolu phononongo.
Ixabiso le-ASP yesibhedlele linokwahluka ngokubanzi ukusuka kwilizwe ukuya kwelinye ilizwe.Nangona kunjalo, kuphononongo olucwangcisiweyo, uDilip et al. [30]wabonisa ukuba emva kokuphunyezwa kwe-ASP, ukugcinwa kweendleko eziqhelekileyo kuhluka ngobukhulu besibhedlele kunye nommandla.Umndilili weendleko zokugcinwa kweendleko kwisifundo sase-US sasiyi-$ 732 ngesigulane (uluhlu lwe-2.50-2640), kunye nesimo esifanayo kwisifundo saseYurophu. Ixabiso lenyanga eliphakathi kwezona zinto zibiza kakhulu yayiyi-2,158 yeebhedi ezili-100 kunye neeyure ze-122.93 zomsebenzi kwiibhedi ezili-100 ngenyanga ngenxa yexesha elityalwe ngabasebenzi bezempilo.
Siyazi ukuba uphando malunga nokungenelela kwe-ASP lunemida emininzi.Iinguqu ezilinganisiweyo ezifana neziphumo ezifanelekileyo zeklinikhi okanye ukunciphisa ixesha elide ekuchaseni ibhaktheriya kwakunzima ukudibanisa nesicwangciso se-ASP esisetyenzisiweyo, inxalenye ngenxa yexesha elifutshane lokulinganisa ukususela kwi-ASP nganye. iphunyeziwe.Ngakolunye uhlangothi, utshintsho kwi-epidemiology ye-AMR yendawo kwiminyaka inokuchaphazela iziphumo zaso nasiphi na isifundo.Ngaphezu koko, uhlalutyo lwamanani aluphumelelanga ukubamba imiphumo eyenzeka ngaphambi kokungenelela kwe-ASP [31].
Kwisifundo sethu, nangona kunjalo, sisebenzise ukuhlalutya kwexesha elingapheliyo kunye namanqanaba kunye neendlela kwinqanaba lokungenelela kwangaphambili njengolawulo lwecandelo emva kokungenelela, ukubonelela ngoyilo olwamkelekileyo lwendlela yokulinganisa imiphumo yokungenelela. amanqaku athile ngexesha apho ungenelelo luphunyeziweyo, inkcazo yokuba ungenelelo luchaphazela ngokuthe ngqo kwiziphumo kwixesha emva kokungenelela luqiniswa kubukho beqela elilawulayo elingazange libe nokungenelela, kwaye ngoko ke, ukusuka kungenelelo lwangaphambili ukuya kwithuba lokungenelela. ixesha emva kokungenelela akukho tshintsho.Ngaphezu koko, uyilo lwechungechunge lwexesha lunokulawula imiphumo ephazamisayo ehambelana nexesha elifana nexesha lonyaka [32, 33]. , kunye nemilinganiselo esemgangathweni, kunye nesidingo semifuziselo yexesha ukuba yomelele ngakumbi ekuhloleni i-ASP.Nangona zonke iingenelo zale ndlela,kukho imida ethile.Inani lokuqwalaselwa, i-symmetry yedatha ngaphambi nangemva kokungenelela, kunye ne-autocorrelation ephezulu yedatha yonke ichaphazela amandla okufunda.Ngoko ke, ukuba kuncitshiswa okubonakalayo kokusetyenziswa kwe-antibiotic kunye nokunciphisa ukuchasana kwebhaktheriya. zixelwa ekuhambeni kwexesha, imodeli yamanani ayisivumeli ukuba sazi ukuba zeziphi izicwangciso ezininzi eziphunyeziweyo ngexesha le-ASP zisebenza kakhulu kuba Yonke imigaqo-nkqubo ye-ASP iphunyezwa ngaxeshanye.
I-Antimicrobial stewardship ibaluleke kakhulu ekujonganeni nezisongelo ze-AMR ezivelayo.Uvavanyo lwe-ASP luchazwa ngokunyukayo kwiincwadi, kodwa iziphene zendlela yokuyila, ukuhlalutya, kunye nokunika ingxelo ngolu ngenelelo luthintela ukutolikwa kunye nokuphunyezwa okubanzi kokungenelela okubonakalayo okuyimpumelelo.Nangona inani leempembelelo ezinkulu. I-ASPs ikhule ngokukhawuleza kumazwe ngamazwe, bekunzima kwi-LMIC ukubonisa impumelelo yeenkqubo ezinjalo.Nangona ezinye izithintelo zendalo, uphononongo oluphezulu oluphazamisekile lwexesha lohlalutyo lunokuba luncedo ekuhlalutyeni ungenelelo lwe-ASP.Kuphononongo lwethu lokuthelekisa ii-ASPs ze izibhedlele ezine, sakwazi ukubonisa ukuba kunokwenzeka ukuphumeza inkqubo enjalo kwindawo yesibhedlele se-LMIC.Sibonisa ngakumbi ukuba i-ASP idlala indima ephambili ekunciphiseni ukusetyenziswa kwe-antibiotics kunye nokuchasana.Sikholelwa ukuba, njengomgaqo-nkqubo wezempilo yoluntu, ii-ASPs. kufuneka bafumane inkxaso yolawulo kazwelonke, kukhunjulwa ukuba nabo ngoku bayinxalenye yamizinto eziqinisekisiweyo zokuvunywa kwesibhedlele ezinxulumene nokhuseleko lwesigulane.
Ixesha lokuposa: May-18-2022