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美国疾控中心:滥用抗生素可能致命

更新时间:2014-3-6 22:25:12 来源:华尔街日报中文网 作者:佚名

CDC: Antibiotic Overuse Can Be Lethal
美国疾控中心:滥用抗生素可能致命

The overuse of antibiotics in U.S. hospitals is putting patients at risk and helping to fuel the creation of deadly superbugs, according to a government report released Tuesday.

Prescribing practices vary widely, with doctors in some facilities providing three times as many antibiotics for patients as physicians in other hospitals treating similar types of patients, concluded the report, produced by the Centers for Disease Control and Prevention.

The CDC analyzed prescribing practices at 323 hospitals in 2010 and 11,282 patients at 183 hospitals in 2011. About 36% of patients studied were given the powerful antibiotic vancomycin without testing or for too long, the report found. Other antibiotics are similarly overused, it said, with nearly 40% of patients being treated for urinary-tract infections with these drugs, the report said.

Other antibiotics are similarly overused, it said, with nearly 40% of patients being treated for urinary-tract infections with these drugs, the report said.

Overprescribing antibiotics is making many of these drugs less effective because superbugs resistant to them are developing so fast. The practice also can sicken patients, by making them vulnerable to other types of infections such as Clostridium difficile, a bacterial infection.

Cutting back antibiotics use by 30% would reduce the number of infections with C. difficile by 26%, the report estimated. About 250,000 hospitalized patients a year develop C. difficile infections, which can lead to sepsis and death.

The findings suggest that while many hospitals recently have moved to crack down on antibiotic overuse, more should be done, the CDC said.

CDC Director Tom Frieden said he has treated patients who had run out of options of antibiotics capable of combating their infections, a frightening situation he doesn't want to see widespread.

'We have to protect patients by protecting antibiotics,' he said. 'The drugs we have today are endangered and any new drugs could be lost just as quickly.'

Of particular concern is overuse of vancomycin because it is 'the workhorse drug' used to treat MRSA, an increasingly common infection, and alternatives to it are expensive, said Arjun Srinivasan, the CDC's associate director for health care-associated infection prevention programs.

In more than 20% of cases studied in which intravenous vancomycin was given, the patient never had MRSA, he noted.

'A person comes into the hospital, they're very sick, they have lots of stuff going on, they're started on antibiotics and in a couple of days they're doing better, so why change anything,' Dr. Srinivasan said, explaining the typical thinking in hospitals. 'We're saying reassess. At 48 hours maybe what you thought was MRSA turned out to be something else. If it's not [MRSA], maybe it is time to stop the vancomycin.'

The government set a goal of cutting the rate of C. difficile infection in half in five years, which the CDC said would save 20,000 lives, prevent 150,000 hospitalizations and trim $2 billion in health-care costs.

President Obama's budget proposal for fiscal 2015 includes $30 million for building an infrastructure to identify resistant bacteria strains and foster communication within communities about outbreaks and treatment, Dr. Frieden said.

The CDC initiative was welcomed by patient advocates, including Mary Brennan-Taylor, whose mother, Alice Brennan, died in 2009 in New York. She checked in to a community hospital with symptoms of gout in her leg and died six weeks later after being diagnosed with multiple hospital-acquired infections.

'We have heard the drumbeat for a number of years now about the overprescribing of painkillers, but make no mistake, the overprescribing of antibiotics is not benign,' she said. 'It can be lethal.'

Most large academic hospitals have 'antibiotic stewardship' programs in place in which physicians and pharmacists review prescribing practices and suggest changes where warranted to cut down on antibiotic use, said Sara Cosgrove, director of the antibiotic stewardship program at Johns Hopkins Hospital in Baltimore. But many community hospitals, where most people in the U.S. are treated, lack such programs, she noted.

'If we leave it at just the tertiary but not the community hospitals, it's not clear that we'll have any national impact,' she said.

美国疾病控制与预防中心(Centers for Disease Control and Prevention,简称CDC)周二发布的报告显示,美国医疗机构滥用抗生素的现象正在把病患置于风险之中并催生致命的超级病菌。

报告指出,美国不同医疗机构给病人开出的抗生素剂量存在很大差别,对类似病情使用的抗生素剂量有时居然相差三倍。

CDC对2010年323家医院的开方情况和2011年183家医院的11,282名病人做了分析,发现36%的病人在没有经过检查的情况下就按医生处方使用了强力抗生素万古霉素,其中有些人还存在用药时间过长的情况。报告称,其他抗生素也存在滥用现象,在治疗尿路感染时有将近40%的病人使用了抗生素。

滥用抗生素的后果是超级病菌的抗药性急剧增强,导致许多抗生素药效减弱。滥用抗生素还导致病人对艰难梭菌(Clostridium difficile)等其他病菌的免疫力下降。

CDC在报告中估计,若将抗生素用量减少30%,艰难梭菌感染病例将减少26%。目前每年有大约25万名住院患者感染艰难梭菌,这种病菌能引发败血症甚至危及生命。

CDC称,尽管许多医院已采取措施抑制抗生素的滥用,但还需要做更多努力。

CDC主任弗里登(Tom Frieden)说,他遇到过对任何抗生素都产生抗药性的病人,他不希望看到这种可怕的现象蔓延开来。

他表示,保护病人先要保护抗生素;现有的药物已经受到威胁,新药物也可能很快失去效用。

CDC负责卫生保健感染预防项目的副主任斯里尼瓦桑(Arjun Srinivasan)说,万古霉素的滥用尤其令人担忧,因为这是一种用于治疗抗药性金黄色葡萄球菌(MRSA)的强效药物。他指出,MRSA的感染现象越来越普遍,而替代万古霉素的药物都十分昂贵。

他指出,在所有使用万古霉素的病例中,有超过20%的病人根本没有感染MRSA。

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