I-Antimicrobial Stewardship Programs (ASPs) ibe yinsika ebalulekile yokuthuthukisa ukusetshenziswa kwe-antimicrobial, ukuthuthukisa ukunakekelwa kwesiguli, nokunciphisa ukumelana ne-antimicrobial (AMR).Lapha, sihlole umthelela we-ASP ekusetshenzisweni kwamagciwane kanye ne-AMR e-Colombia.
Sakhe ukucwaninga kokubheka okubuyela emuva futhi salinganisa izitayela ekusetshenzisweni kwamagciwane kanye ne-AMR ngaphambi nangemva kokuqaliswa kwe-ASP esikhathini esiyiminyaka emi-4 (izinyanga ezingu-24 ngaphambi nezinyanga ezingu-24 ngemva kokuqaliswa kwe-ASP) sisebenzisa ukuhlaziywa kochungechunge lwesikhathi oluphazanyiswe.
Ama-ASP asetshenziswa ngokusekelwe ezinsizeni ezitholakalayo zesikhungo ngasinye.Ngaphambi kokuqaliswa kwe-ASP, kwakunomkhuba wokwanda kokusetshenziswa kwama-antibiotic kuzo zonke izilinganiso ezikhethiwe zemithi elwa namagciwane.Ngemva kwalokho, ukwehla okuphelele kokusetshenziswa kwama-antibiotic kwabonakala.Ukusetshenziswa kwe-Ertapenem ne-meropenem kwehle ngo amawodi asesibhedlela, kuyilapho i-ceftriaxone, i-cefepime, i-piperacillin/tazobactam, i-meropenem, ne-vancomycin zehla emagumbini okunakekela abagula kakhulu. Umkhuba wokwanda kwe-Staphylococcus aureus engamelana ne-oxacillin, i-Escherichia coli engamelana ne-ceftriaxone, kanye nokuqaliswa kwe-meropeneseuresis-SP ye-meropenseuresis yayiyi-meropenseuresis-resistant SP. .
Ocwaningweni lwethu, sibonisa ukuthi i-ASP iyisu eliyisihluthulelo ekubhekaneni nosongo oluvelayo lwe-AMR futhi ibe nomthelela omuhle ekuncipheni nokumelana nama-antibiotic.
Ukumelana ne-Antimicrobial (AMR) kuthathwa njengosongo lomhlaba wonke empilweni yomphakathi [1, 2], okubangela ukufa kwabantu abangaphezu kuka-700,000 ngonyaka.Ngo-2050, inani lokufa lingase libe phezulu njengezigidi ezingu-10 ngonyaka [3] futhi lingalimaza umonakalo omkhulu. umkhiqizo wasekhaya wamazwe, ikakhulukazi amazwe anemali engenayo ephansi naphakathi (LMICs) [4].
Ukuvumelana nezimo okuphezulu kwama-microorganisms kanye nobudlelwano phakathi kokusetshenziswa kabi kwamagciwane kanye ne-AMR kwaziwa amashumi eminyaka [5].Ngo-1996, uMcGowan noGerding babiza “ukuphatha ukusetshenziswa kwama-antimicrobial,” okuhlanganisa ukwenziwa ngcono kokukhethwa kwama-antimicrobial, umthamo, kanye nobude besikhathi sokwelashwa, ukuze kubhekwane nayo. usongo olusafufusa lwe-AMR [6].Kule minyaka embalwa edlule, izinhlelo zokuphatha i-antimicrobial stewardship (ASPs) zibe yinsika yokuthuthukisa ukusetshenziswa kwama-antimicrobial ngokwenza ngcono ukubambelela eziqondisweni zama-antimicrobial futhi zaziwa ngokwenza ngcono ukunakekelwa kwesiguli kuyilapho zinomthelela omuhle ku-AMR. [7, 8].
Amazwe anemali engenayo ephansi kanye nemaphakathi ngokuvamile anezigameko eziphezulu ze-AMR ngenxa yokuntuleka kokuhlolwa kokuxilonga okusheshayo, ama-antimicrobial esizukulwane sokugcina, nokubhekwa kwe-epidemiological surveillance [9], ngakho-ke amasu agxile ku-ASP njengokuqeqeshwa ku-inthanethi, izinhlelo zokuqondisa, imihlahlandlela kazwelonke. , kanye nokusetshenziswa kwezinkundla zokuxhumana sekuyinto ehamba phambili [8].Nokho, ukuhlanganiswa kwalawa ma-ASP kuyinselele ngenxa yokuntuleka njalo kochwepheshe bezokunakekelwa kwempilo abaqeqeshelwe ukuphatha ama-antimicrobial, ukuntuleka kwamarekhodi ezokwelapha nge-elekthronikhi, kanye nokuntuleka kwezwe lonke. inqubomgomo yezempilo yomphakathi ukubhekana ne-AMR [9].
Ucwaningo oluningana lwasesibhedlela lweziguli ezilaliswe esibhedlela lubonise ukuthi i-ASP ingathuthukisa ukunamathela eziqondisweni zokwelashwa kwe-antimicrobial futhi inciphise ukusetshenziswa okungadingekile kwama-antibiotic, kuyilapho ibe nemiphumela emihle kumazinga e-AMR, izifo ezitholwa esibhedlela, nemiphumela yesiguli [8, 10, 11], 12]. Ukungenelela okuphumelelayo kakhulu kufaka phakathi ukubuyekezwa okuzokwenzeka kanye nempendulo, ukugunyazwa kwangaphambili, kanye nezincomo zokwelashwa eziqondene nendawo ethile [13].Nakuba impumelelo ye-ASP ishicilelwe eLatin America, kunemibiko embalwa mayelana nomthelela womtholampilo, we-microbiological, kanye nomnotho walokhu kungenelela. [14,15,16,17,18].
Inhloso yalolu cwaningo kwakuwukuhlola umthelela we-ASP ekusetshenzisweni kwama-antibiotic kanye ne-AMR ezibhedlela ezine eziyinkimbinkimbi kakhulu e-Colombia kusetshenziswa ukuhlaziywa kochungechunge lwesikhathi oluphazanyiswe.
Ucwaningo lokuhlola okubukwayo kwezindlu ezine emadolobheni amabili aseColombia (i-Cali ne-Barranquilla) esikhathini esiyizinyanga ezingu-48 kusukela ku-2009 kuya ku-2012 (izinyanga ezingu-24 ngaphambi nezinyanga ezingu-24 ngemva kokuqaliswa kwe-ASP) Kwenziwa ezibhedlela eziyinkimbinkimbi kakhulu (izikhungo AD) . I-Acinetobacter baumannii engamelana ne-meropenem (MEM-R Aba), i-E. coli engamelana ne-ceftriaxone (CRO-R Eco), i-Klebsiella pneumoniae (ETP-R Kpn) engamelana ne-ertapenem, Izehlakalo ze-Ropenem Pseudomonas aeruginosa (ME-R Kpn) I-Staphylococcus aureus (i-OXA-R Sau) engamelana ne-oxacillin (i-OXA-R Sau) yalinganiswa ngesikhathi socwaningo.Ukuhlola okuyisisekelo kwe-ASP kwenziwa ekuqaleni kwesikhathi socwaningo, okulandelwa ukuqapha ukuqhubeka kwe-ASP ezinyangeni eziyisithupha ezilandelayo kusetshenziswa i-Indicative Compound Antimicrobial (ICATB) I-Antimicrobial Stewardship Index [19].Isilinganiso sezibalo ze-ICATB zabalwa.Amawadi ajwayelekile kanye namayunithi okunakekela kakhulu (ICUs) afakwe ekuhlaziyweni.Amakamelo ezimo eziphuthumayo kanye nezigceme zezingane ayengafakwanga ocwaningweni.
Izici ezivamile ze-ASP yesikhungo esibambe iqhaza zifaka: (1) Amaqembu e-ASP ezinhlobonhlobo eziningi: odokotela bezifo ezithathelwanayo, osokhemisi, izazi ze-microbiology, abaphathi abahlengikazi, amakomiti okulawula ukutheleleka kanye nokuvimbela;(2) Iziqondiso zokulwa namagciwane zezifo ezivame kakhulu, ezibuyekezwa ithimba le-ASP futhi zisekelwe ku-epidemiology yesikhungo;(3) ukuvumelana phakathi kochwepheshe abahlukene ngeziqondiso zokulwa namagciwane ngemva kwengxoxo nangaphambi kokuqaliswa;(4) ukucwaninga okulindelwe kanye nempendulo kuyisu lazo zonke izikhungo ngaphandle kwesikhungo esisodwa (isikhungo D sasebenzisa imibandela evimbelayo (5) Ngemva kokuqala kokwelashwa ngama-antibiotic, ithimba le-ASP (ikakhulukazi i-GP elibika kudokotela wezifo ezithathelwanayo) libuyekeza incwadi kadokotela ekhethiwe. i-antibiotic eqinisekisiwe futhi inikeza impendulo eqondile kanye nezincomo zokuqhubeka, ukulungisa, ukuguqula noma ukuyeka ukwelashwa; (6) ukungenelela okuvamile (njalo ngezinyanga ze-4-6) ukukhumbuza odokotela ngemikhombandlela ye-antimicrobial; (7) ukusekelwa kokuphathwa kwesibhedlela ukungenelela kweqembu le-ASM.
Imithamo yansuku zonke echaziwe (DDDs) esekelwe ohlelweni lokubala lweNhlangano Yezempilo Yomhlaba (WHO) yasetshenziswa ukukala ukusetshenziswa kwama-antibiotic.I-DDD ngezinsuku zokulala eziyi-100 ngaphambi nangemuva kokungenelela nge-ceftriaxone, i-cefepime, i-piperacillin/tazobactam, i-ertapenem, i-meropenem, ne-vancomycin yayirekhodwa nyanga zonke esibhedlela ngasinye.Amamethrikhi omhlaba azo zonke izibhedlela akhiqizwa inyanga ngayinye ngesikhathi sokuhlola.
Ukukala izehlakalo ze-MEM-R Aba, CRO-R Eco, ETP-R Kpn, MEM-R Pae, ne-OXA-R Sau, inani leziguli ezinezifo ezitholwe esibhedlela (ngokwe-CDC kanye ne-microbial culture-positive prophylaxis [CDC] Surveillance System Standards) ihlukaniswe ngenani labangeniswa esibhedlela ngasinye (ezinyangeni eziyi-6) × iziguli ezilaliswa yiziguli eziyi-1000. Yisidwana esisodwa kuphela sohlobo olufanayo olwafakwa esigulini ngasinye. Ngakolunye uhlangothi, azikho izinguquko ezinkulu ekuhlanzekeni kwesandla. , izinyathelo zokuphepha zokuzihlukanisa, amasu okuhlanza kanye nokubulala amagciwane ezibhedlela ezine.Phakathi nesikhathi sokuhlola, iphrothokholi esetshenziswe yiKomidi Lokulawula Nokuvimbela Ukutheleleka ayizange ishintshe.
Imihlahlandlela yango-2009 kanye neka-2010 ye-Clinical and Laboratory Standards Institute (CLSI) yasetshenziswa ukuze kutholwe izitayela zokungazweli, kucatshangelwa ukunqamuka kokuzwela kwe-isolate ngayinye ngesikhathi socwaningo, ukuze kuqinisekiswe ukuqhathaniswa kwemiphumela.
Ukuhlaziywa kochungechunge lwesikhathi okuphazanyisiwe ukuze kuqhathaniswe ukusetshenziswa kwanyanga zonke kwanyanga zonke kwezidakamizwa ze-DDD emhlabeni wonke kanye nezinyanga eziyisithupha ezehlakalo ezikhulayo ze-MEM-R Aba, i-CRO-R Eco, i-ETP-R Kpn, i-MEM-R Pae, ne-OXA-R Sau emawadini asesibhedlela nasezikhungweni zabagula kakhulu. .Ukusetshenziswa kwama-antibiotic, ama-coefficients kanye nesigameko sokutheleleka kwangaphambi kokungenelela, izitayela ngaphambi nangemva kokungenelela, kanye nezinguquko kumazinga aphelele ngemva kokungenelela zirekhodiwe.Izincazelo ezilandelayo zisetshenziswa: β0 iyinto engaguquki, i-β1 iyi-coefficient yethrendi yangaphambi kokungenelela , i-β2 iwushintsho lwethrendi, futhi i-β3 iyithrendi yangemva kokungenelela [20].Ukuhlaziywa kwezibalo kwenziwa ku-STATA® 15th Edition.I-p-value engu-<0.05 ibhekwe njengebalulekile ngokwezibalo.
Izibhedlela ezine zafakwa phakathi nokulandelwa kwezinyanga ezingama-48;izici zabo ziboniswe kuThebula 1.
Nakuba zonke izinhlelo zaziholwa izazi ze-epidemiologists noma odokotela bezifo ezithathelwanayo (Ithebula 2), ukusatshalaliswa kwezinsiza zabantu kuma-ASPs kwahlukahluka ezibhedlela.Izindleko ezijwayelekile ze-ASP zaziyi-$ 1,143 ngemibhede eyi-100. Izikhungo D no-B zachitha isikhathi eside kakhulu sokungenelela kwe-ASP, ukusebenza amahora angu-122.93 kanye namahora angu-120.67 ngemibhede eyi-100 ngenyanga, ngokulandelana.Odokotela bezifo ezithathelwanayo, odokotela bezifo eziwumshayabhuqe kanye nosokhemisi basesibhedlela kuzo zombili izikhungo bebenamahora aphezulu ngokomlando.I-Institution D's ASP yayilinganiselwa ku-$2,158 ngemibhede eyi-100 ngenyanga, futhi kwakuyinto ebiza kakhulu phakathi kwengu-4 izikhungo ngenxa yongoti abazinikele kakhulu.
Ngaphambi kokuqaliswa kwe-ASP, lezi zikhungo ezine zazinezinga eliphezulu kakhulu lemithi elwa namagciwane (i-ceftriaxone, i-cefepime, i-piperacillin/tazobactam, i-ertapenem, i-meropenem, ne-vancomycin) ezigcemeni ezijwayelekile nasema-ICU.Kunomkhuba okhulayo wokusetshenziswa (Umfanekiso 1) .Ngemva kokuqaliswa kwe-ASP, ukusetshenziswa kwama-antibiotic kwehle kuzo zonke izikhungo;isikhungo B (45%) sehle kakhulu, salandelwa yizikhungo A (29%), D (28%), kanye no-C (20%).Isikhungo C sihoxise ukuthambekela kokusetshenziswa kwama-antibiotic, amazinga aphansi kakhulu kunesokuqala. isikhathi sokufunda uma siqhathaniswa nesikhathi sesithathu sangemva kokuqaliswa (p <0.001) .Ngemva kokuqaliswa kwe-ASP, ukusetshenziswa kwe-meropenem, i-cefepime, kanyei-ceftriaxonekwehle kakhulu kuya ku-49%, 16%, no-7% ezikhungweni C, D, kanye no-B, ngokulandelana (p <0.001). Ukusetshenziswa kwe-vancomycin, i-piperacillin/tazobactam, ne-ertapenem bekungehlukanga ngokwezibalo. Esimeni A, ukunciphisa ukusetshenziswa kwe-meropenem, i-piperacillin/tazobactam, kanyei-ceftriaxonekwaqashelwa onyakeni wokuqala ngemva kokuqaliswa kwe-ASP, nakuba ukuziphatha kungabonisanga noma iyiphi inkambiso enciphayo onyakeni olandelayo (p > 0.05).
Izitayela ze-DDD ekusetshenzisweni kwama-antibiotic abanzi (i-ceftriaxone, i-cefepime, i-piperacillin/tazobactam, i-ertapenem, i-meropenem, ne-vancomycin) e-ICU nasezigcemeni ezijwayelekile
Ukuthambekela okuphezulu okuphawulekayo kwezibalo kwabonwa kuwo wonke ama-antibiotic ahlolwe ngaphambi kokuba i-ASP isetshenziswe ezigcemeni zesibhedlela.Ukusetshenziswa kwe-ertapenem ne-meropenem kwehle ngokwezibalo ngokuphawulekayo ngemva kokuqaliswa kwe-ASP.Nokho, akukho kuncipha okuphawulekayo okubonwe ekusetshenzisweni kwamanye ama-antibiotic (Ithebula 3 ).Mayelana ne-ICU, ngaphambi kokuqaliswa kwe-ASP, ukuthambekela okuphezulu ngokwezibalo kwaqashelwa kuwo wonke ama-antibiotic ahloliwe, ngaphandle kwe-ertapenem ne-vancomycin.Ngokulandela ukuqaliswa kwe-ASP, ukusetshenziswa kwe-ceftriaxone, i-cefepime, i-piperacillin/tazobactam, i-meropenem, ne-vancomycin yehla.
Ngokuqondene namabhaktheriya amelana nemithi eminingi, kube khona ukuthambekela okubalulekile ngokwezibalo ku-OXA-R Sau, i-MEM-R Pae, ne-CRO-R Eco ngaphambi kokuqaliswa kwama-ASP.Ngokuphambene, amathrendi e-ETP-R Kpn kanye ne-MEM-R U-Aba ubengabalulekile ngokwezibalo. Amathrendi we-CRO-R Eco, MEM-R Pae, ne-OXA-R Sau ashintshile ngemva kokuqaliswa kwe-ASP, kuyilapho amathrendi e-MEM-R Aba kanye ne-ETP-R Kpn ayengabalulekile ngokwezibalo (Ithebula 4 ).
Ukusetshenziswa kwe-ASP kanye nokusetshenziswa kahle kwama-antibiotic kubalulekile ukucindezela i-AMR [8, 21].Ocwaningweni lwethu, sibone ukuncipha kokusetshenziswa kwemithi ethile elwa namagciwane ezikhungweni ezintathu kwezine ezicwaningiwe.Amaqhinga amaningana asetshenziswa izibhedlela angase abe nomthelela empumelelweni. lama-ASP alezi zibhedlela.Iqiniso lokuthi i-ASP yakhiwe ithimba lezinhlaka ezahlukene lochwepheshe libalulekile njengoba linomthwalo wemfanelo wokuxhumana nabantu, ukusebenzisa, nokulinganisa ukuthotshelwa kweziqondiso zokulwa namagciwane.Amanye amasu aphumelelayo ahlanganisa ukuxoxa ngeziqondiso zokulwa namagciwane nochwepheshe abanikeza imithi ngaphambi kokuqaliswa. I-ASP kanye nokwethula amathuluzi okuqapha ukusetshenziswa kwama-antibiotic, angasiza ukugcina amathebhu kunoma yiziphi izinguquko ekunikeni ama-antibacterial.
Izikhungo zokunakekelwa kwezempilo ezisebenzisa ama-ASP kumele zivumelane nokungenelela kwazo ezinsizeni ezitholakalayo zabantu kanye nokusekelwa kwabakhokhelwayo kwethimba le-antimicrobial stewardship.Okuhlangenwe nakho kwethu kufana nalokho okwabikwa nguPerozziello kanye nozakwethu esibhedlela saseFrance [22].Esinye isici esibalulekile kwaba ukusekelwa kwesibhedlela ukuphathwa esikhungweni socwaningo, okwenza kube lula ukuphatha ithimba lomsebenzi we-ASP.Ngaphezu kwalokho, ukwaba isikhathi somsebenzi kochwepheshe bezifo ezithathelwanayo, osokhemisi basesibhedlela, odokotela abajwayelekile kanye nabezimo eziphuthumayo kuyisici esibalulekile sokuqaliswa ngempumelelo kwe-ASP [23].Ezikhungweni B kanye no-C, ukuzinikela kodokotela isikhathi esibalulekile sokusebenzisa i-ASP kungenzeka kube nomthelela ekuhambisaneni kwabo okuphezulu neziqondiso zokulwa namagciwane, okufana nalokho okwabikwa nguGoff kanye nozakwabo [24] .Esikhungweni C, umhlengikazi oyinhloko wayenomthwalo wemfanelo wokuqapha ukunamathela kwama-antimicrobial kanye sebenzisa futhi unikeze impendulo yansuku zonke kodokotela.Lapho kwakukhona ama-dis athathelwanayo ambalwa noma eyodwa kuphelalula uchwepheshe kuyo yonke imibhede engu-800, imiphumela emihle kakhulu etholwe nge-ASP eqhutshwa umhlengikazi yayifana naleyo yocwaningo olushicilelwe nguMonses [25].
Ngemva kokuqaliswa kwe-ASP ezigcemeni ezivamile zezikhungo zokunakekelwa kwezempilo ezine e-Colombia, umkhuba oyancipha ekusetshenzisweni kwawo wonke ama-antibiotics ahloliwe wabonakala, kodwa kuphela ngokwezibalo okubaluleke kakhulu kuma-carbapenems. amagciwane amelana nemithi eminingi [26,27,28,29].Ngakho-ke, ukunciphisa ukusetshenziswa kwawo kuzoba nomthelela emvelweni wezitshalo ezimelana nezidakamizwa ezibhedlela kanye nokonga izindleko.
Kulolu cwaningo, ukuqaliswa kwe-ASP kubonise ukwehla kwesigameko se-CRO-R Eco, i-OXA-R Sau, i-MEM-R Pae, ne-MEM-R Aba.Ezinye izifundo e-Colombia nazo zibonise ukuncipha kwe-beta ye-spectrum enwetshiwe. -i-lactamase (ESBL)-ekhiqiza i-E. coli kanye nokwanda kokumelana ne-cephalosporins yesizukulwane sesithathu [15, 16].Ucwaningo luphinde lwabika ukuncipha kwesigameko se-MEM-R Pae ngokulandela ukuphathwa kwe-ASP [16, 18] namanye ama-antibiotics. njenge-piperacillin/tazobactam kanye ne-cefepime [15, 16].Umklamo walolu cwaningo awukwazi ukukhombisa ukuthi imiphumela yokumelana nebhaktheriya ibangelwa ngokuphelele ukuqaliswa kwe-ASP.Ezinye izici ezithonya ukuncishiswa kwamagciwane amelana nazo zingahlanganisa ukunamathela okwengeziwe ekuhlanzekeni kwezandla. kanye nezinqubo zokuhlanza nokubulala amagciwane, kanye nokuqwashisa okuvamile kwe-AMR, okungenzeka noma kungafaneleki ekuqhutshweni kwalolu cwaningo.
Inani lama-ASP ezibhedlela lingahluka kakhulu kuye ngamazwe.Nokho, ekubuyekezeni okuhlelekile, u-Dilip et al.[30]kubonise ukuthi ngemva kokuqaliswa kwe-ASP, ukonga kwezindleko okumaphakathi kuyahlukahluka ngobukhulu besibhedlela kanye nesifunda.Isilinganiso sokonga izindleko ocwaningweni lwase-US sasingu-$732 ngesiguli ngasinye (ububanzi obungu-2.50-2640), nokuthambekela okufanayo ocwaningweni lwaseYurophu. isilinganiso sezindleko zanyanga zonke zezinto ezibiza kakhulu kwakungu-$2,158 ngemibhede eyi-100 kanye namahora okusebenza angu-122.93 ngemibhede eyi-100 ngenyanga ngenxa yesikhathi esitshalwe ochwepheshe bezokunakekelwa kwempilo.
Siyazi ukuthi ucwaningo ngokungenelela kwe-ASP lunemikhawulo eminingana.Iziguquko ezilinganisiwe ezifana nemiphumela emihle yomtholampilo noma ukunciphisa isikhathi eside ekuphikisweni kwamagciwane kwakunzima ukuhlobanisa nesu le-ASP elisetshenzisiwe, ngokwengxenye ngenxa yesikhathi sokulinganisa esifushane kusukela ku-ASP ngayinye. isetshenziswe.Ngakolunye uhlangothi, izinguquko ku-AMR wendawo epidemiology phakathi neminyaka ingase ithinte imiphumela yanoma yiluphi ucwaningo.Ngaphezu kwalokho, ukuhlaziya kwezibalo kuhlulekile ukuthatha imiphumela eyenzeka ngaphambi kokungenelela kwe-ASP [31].
Nokho, esifundweni sethu, sisebenzise ukuhlaziya kochungechunge lwesikhathi olungaqhubeki olunamazinga namathrendi esigabeni sangaphambi kokungenelela njengezilawuli zengxenye yangemva kokungenela, sinikeza idizayini eyamukelekayo ngendlela yokulinganisa imiphumela yokungenela.Njengoba amakhefu ochungechungeni lwesikhathi ebhekisela ku amaphuzu athile ngesikhathi lapho ukungenelela kusetshenziswe khona, ukucatshangelwa kokuthi ukungenelela kuthinta ngokuqondile imiphumela esikhathini sangemva kokungenelela kuqiniswa ukuba khona kweqembu elilawulayo elingakaze libe nokungenelela, futhi ngaleyo ndlela, kusukela ekungeneleleni kwangaphambili kuya ku- isikhathi sangemva kokungenela akunashintsho.Ngaphezu kwalokho, imiklamo yochungechunge lwesikhathi ingalawula imiphumela edidayo ehlobene nesikhathi njengenkathi yonyaka [32, 33].Ukuhlolwa kwe-ASP yokuhlaziywa kochungechunge lwesikhathi esiphazamisekile kudingekile kakhulu ngenxa yesidingo samasu amisiwe, izilinganiso zomphumela. , kanye nezinyathelo ezijwayelekile, kanye nesidingo samamodeli esikhathi ukuthi aqine kakhulu ekuhloleni i-ASP.Naphezu kwazo zonke izinzuzo zale ndlela,kukhona ukulinganiselwa okuthile.Inani lokubhekwa, ukulinganisa kwedatha ngaphambi nangemva kokungenelela, kanye nokulinganisa okuzenzakalelayo okuphezulu kwedatha konke kuthinta amandla ocwaningo.Ngakho-ke, uma ukuncipha okuphawulekayo kokusetshenziswa kwama-antibiotic kanye nokunciphisa ukumelana namagciwane. ziyabikwa ngokuhamba kwesikhathi, imodeli yezibalo ayisivumeli ukuthi sazi ukuthi yimaphi amasu amaningi asetshenziswa ngesikhathi se-ASP asebenza kahle kakhulu ngoba Zonke izinqubomgomo ze-ASP zisetshenziswa kanyekanye.
Ubuphathi bemithi elwa namagciwane bubalulekile ekubhekaneni nezinsongo ze-AMR ezivelayo.Ukuhlolwa kwe-ASP kuya ngokuya kubikwa ezincwadini, kodwa amaphutha endlela yokuklama, ukuhlaziya, kanye nokubikwa kwalokhu kungenelela kuvimbela ukuchazwa kanye nokuqaliswa okubanzi kokungenelela okubonakala kuyimpumelelo.Nakuba isibalo esikhulu Ama-ASP akhule ngokushesha emazweni ngamazwe, kube nzima ku-LMIC ukukhombisa impumelelo yalezo zinhlelo.Naphezu kwemikhawulo ethile engokwemvelo, izifundo zokuhlaziya uchungechunge lwezikhathi eziphazanyiswe izinga eliphezulu zingase zibe usizo ekuhlaziyeni ukungenelela kwe-ASP.Ocwaningweni lwethu lokuqhathanisa ama-ASP ezibhedlela ezine, sakwazi ukukhombisa ukuthi kungenzeka ukusebenzisa uhlelo olunjalo esimweni sesibhedlela se-LMIC.Siphinde sibonisa ukuthi i-ASP idlala indima ebalulekile ekunciphiseni ukusetshenziswa kwama-antibiotic kanye nokungazweli.Sikholelwa ukuthi, njengenqubomgomo yezempilo yomphakathi, ama-ASPs kumele bathole ukwesekwa kokulawula kukazwelonke, kukhunjulwe ukuthi nabo njengamanje bayingxenye yamiizici eziqinisekisiwe zokugunyazwa esibhedlela ezihlobene nokuphepha kwesiguli.
Isikhathi sokuthumela: May-18-2022