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美国尝试用酸奶抵御致命病菌

更新时间:2013-11-22 21:44:22 来源:华尔街日报中文网 作者:佚名

Hospitals Try Yogurt to Prevent Infections in Patients
美国尝试用酸奶抵御致命病菌

At Holy Redeemer Hospital in Meadowbrook, Pa., a worrisome trend emerged in 2011: an uptick in cases of one of the most virulent hospital infections, despite measures to battle the bug by scrubbing surfaces with bleach and isolating affected patients.

2011年,一种令人担忧的致命病菌在宾夕法尼亚州梅多布鲁克市的 救世主医院(Holy Redeemer Hospital)蔓延,尽管该医院用漂白剂对表面进行消毒并隔离了感染病人,病例数量仍不断攀升。

But the hospital was able to drive down cases last year after adding a new weapon to its arsenal: probiotics, the small organisms that help maintain the natural balance of bacteria in the intestines.

然而去年在一种新型武器的帮助下,医院成功降低了该病的病例数量。它就是益生菌──一种能帮助肠道菌群维持自然平衡的微生物。

Contained in supplements and foods such as yogurt, probiotics are of growing interest in health care for their potential in helping to treat a number of conditions, including irritable bowel syndrome, tooth decay and chronic fatigue syndrome.

补充剂和酸奶等食品中常含有益生菌。近来人们对益生菌的兴趣愈加浓厚,因为它能辅助治疗多类健康疾病,包括肠易激综合症、龋齿以及慢性疲劳综合症。

Now, Holy Redeemer and other hospitals are experimenting with probiotics as a preventive measure for patients who are on antibiotics. For all their infection-fighting power, antibiotics kill the good bugs along with the bad in the intestine. The result is an imbalance in the gut that can lead a bacterium known as Clostridium difficile -- C. diff for short -- to colonize and produce a toxin that can cause diarrhea, dehydration and fever. In severe cases, C. diff infections can lead to kidney failure, recurrent infection and death.

现在 救世主等多家医院正在进行试验,将益生菌作为一种预防措施用于使用抗生素药物的病人。具有抗感染能力的抗生素在消灭肠道内有害菌的同时,也杀死了有益菌群。这会致使肠道失衡,并导致一种叫做艰难梭菌(Clostridium difficile)的细菌在体内繁殖。这种细菌在肠道内繁衍,所产生的毒素会引发腹泻、脱水和发热,若进一步加重则可导致肾衰竭、复发感染乃至死亡。

C. diff spores are hardy, surviving on surfaces such as doorknobs and countertops. Soap and water can remove them from hands, but alcohol-based hand cleaners commonly used in hospitals don't effectively destroy them. According to the Centers for Disease Control and Prevention, C. diff is rapidly increasing and is linked to 14,000 deaths annually. A study earlier this year in JAMA Internal Medicine estimated the infections cost as much as $1.8 billion annually. Hospital patients with a positive clinical culture for C. diff are 40% likelier to be readmitted within a year than other patients, according to a 2012 study.

艰难梭菌生存力强,常存活于门把手、工作台等表面。用肥皂洗手可以将它们清除,但医院惯常使用的含酒精洗手液无法将其有效杀灭。据美国疾病预防与控制中心(Centers for Disease Control and Prevention)称,艰难梭菌数量正快速增加,每年导致14,000人死亡。根据美国医学会(American Medical Association)杂志《JAMA内科医学》(JAMA Internal Medicine)今年早先发表的研究估计,这类细菌感染导致了每年高达18亿美元的医疗成本。根据2012年的一项研究,携带有艰难梭菌的住院患者一年内再次入院的几率比其他病人高40%。

Probiotics also are being studied in patients who suffer from a less severe but often debilitating complication, antibiotic-associated diarrhea. Analyses by researchers at Maimonides Medical Center in Brooklyn, N.Y., in 2011 found that using probiotics for periods ranging from a few days to three weeks reduced a patient's odds of developing antibiotic-associated diarrhea by 60%. And a RAND Corp. study last year of many published studies also found probiotics useful in preventing or treating antibiotic-associated diarrhea.

益生菌还被用于研究危险较小但病情严重的并发症──抗生素相关腹泻的治疗。2011年,纽约布鲁克林区玛摩利医疗中心(Maimonides Medical Center)研究员的分析显示,使用了几天到三周不等的益生菌后,患者罹患抗生素相关腹泻的几率下降了60%。兰德公司(RAND Corp.)去年对多项已发表研究的调查也显示,益生菌能有效预防、治疗抗生素相关腹泻。

There are several different strains and multiple formulations of probiotics, and research is lacking on the most effective type and dosage, though data has shown that the strains Lactobacillus and Bifidobacterium seem to be most effective.

益生菌有数种不同菌群和多种配型,现在尚未研究出哪种、多大剂量的益生菌效果最佳,不过数据显示乳酸菌(Lactobacillus)和双歧杆菌(Bifidobacterium)最有效。

Erik R. Dubberke, associate professor at Washington University School of Medicine in St. Louis, says there isn't enough data to endorse probiotics for routine C. diff prevention in hospitalized patients. Probiotics may also actually cause infection in some patients, 'so they are not entirely without risk,' Dr. Dubberke notes.

圣路易斯的华盛顿大学医学院副教授埃里克·杜贝克(Erik R. Dubberke)说,现在还没有足够的数据确保益生菌能用于住院患者对艰难梭菌的日常预防工作。杜贝克补充道,益生菌实际上也可能会导致一些患者感染,所以它们也并非毫无危险。

However, he says, probiotics are worth investigating further. He is conducting a study of intensive-care patients, randomizing them to a probiotic Lactobacillus rhamnosus (sold under the brand name Culturelle) or no probiotic. Based on the preliminary findings, he plans a second, larger study to look at how many patients on antibiotics become colonized with C. diff and how many develop an infection.

但他认为益生菌值得进一步探究。他正在对一些重症监护病人进行研究,将他们随机分成两组,一组使用Cuturelle牌鼠李糖乳酸杆菌,另一组不使用乳酸菌。他计划以初步数据为基础,再进行一项规模更大的研究,来调查多少患者使用抗生素后艰难梭菌在体内繁殖,以及多少患者出现了进一步的感染症状。

Holy Redeemer won an innovation award this year from the Hospital and Healthsystem Association of Pennsylvania for the probiotics program, which grew from a suggestion by a surgeon on the hospital's infection-prevention committee. Anne Kathryn Bromm, clinical nutrition coordinator, and Jeanie Ryan, clinical nutrition manager, used a Dannon yogurt brand stocked by the hospital. (Not all yogurts have the same cultures, and makers sometimes add extra ones to claim more benefits.)

救世主医院凭藉其益生菌项目荣获了宾州医疗卫生系统协会(Hospital and Healthsystem Association of Pennsylvania)创新奖。这一项目始自医院感染预防协会一位外科医生的提议。临床营养协调员安妮·凯瑟琳·布罗姆(Anne Kathryn Bromm)和临床营养经理珍妮·瑞安(Jeanie Ryan)使用医院库存中的Dannon牌酸奶用于治疗。(并非所有酸奶都含有同样的益生菌,有时制造商还会在酸奶中额外添加益生菌以对外宣传饮用这种酸奶的好处更多)。

Starting in January 2012, dietitians got a daily list of patients who had orders for antibiotics for more than one day, and met with each to discuss the potential benefits of probiotics, suggesting two six-ounce portions of yogurt daily. 'Patients were pretty agreeable,' Ms. Bromm says.

自2012年1月起,该医院的营养学家拿到了一份抗生素使用时间超过一天的患者名单,与他们面对面谈论益生菌的潜在益处,并建议他们每天食用两份6盎司的酸奶。布罗姆说,患者们都很乐意支持这一计划。

The number of C. diff cases fell to 23 infections in 2012, a 4% infection rate, from 75 in 2011, a 12.5% rate. This year, through September, there were 18 infections. On average, studies show, the infections cost $35,000 to treat, and Ms. Ryan says the savings 'more than compensate for the cost of the yogurt.'

艰难梭菌的病例数量从2011年的75例下降至2012年的23例,感染率从12.5%下降至4%。今年1-9月艰难梭菌感染病例为18例。调查显示,感染的平均治疗成本为35,000美元,瑞安说食用酸奶所省下的钱远远弥补了购买酸奶所花的钱。

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