Antibiotic use and resistance in emerging economies: a situation analysis for Viet Nam.
Antibiotic use and resistance in emerging economies: a situation analysis for Viet Nam.
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DOI：
10.1186/1471-2458-13-1158
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发表时间：
2013-12-10
影响因子：
4.5
通讯作者：
Wertheim HF
中科院分区：
文献类型：
--
作者：
Nguyen KV;Thi Do NT;Chandna A;Nguyen TV;Pham CV;Doan PM;Nguyen AQ;Thi Nguyen CK;Larsson M;Escalante S;Olowokure B;Laxminarayan R;Gelband H;Horby P;Thi Ngo HB;Hoang MT;Farrar J;Hien TT;Wertheim HF
抗微生物药物耐药性是当代主要的公共卫生威胁。已经全面提出了控制抗微生物药物耐药性的战略，但在最需要有效抗微生物药物的发展中国家，实施工作证明存在问题。更好地了解新兴经济体中抗生素使用和耐药性的模式和决定因素，可能允许更有针对性的干预措施。越南人口众多，传染病负担高，获得药物的机会相对不受限制，是新兴经济体在控制抗微生物药物耐药性方面面临困难的一个很好的研究案例。我们的工作组对越南目前抗生素使用和耐药性的模式和决定因素进行了情况分析。对1990年1月1日至2012年8月31日期间发表的国际出版物和当地报告进行了审查。所有利益攸关方在一次政策研讨会上分析了调查结果，并提出了改善越南抗生素使用的可行建议。在这里，我们报告了我们的情况分析结果，重点是：医疗保健系统，药品监管和供应；抗生素耐药性和感染控制；农业抗生素的使用。市场改革改善了越南的医疗服务可及性，促进了更好的健康成果。然而，随着可及性的提高，医院和社区不明智地使用抗生素，可预见细菌耐药性的升级。开处方的做法很差，自我药疗很常见——通常是获得医疗保健的最实惠的方式。存在许多规范抗生素使用的政策，但执行力度不足或缺乏。肺炎球菌青霉素耐药率在亚洲最高，最近出现了碳青霉烯耐药细菌（特别是NDM-1）。医院获得性感染，主要是多重耐药革兰氏阴性菌，给有限的资源带来了额外的压力。农业抗生素的广泛使用进一步传播了抗菌素耐药性。未来关于抗生素获取的立法必须改变对购买者和提供者的激励措施，并确保有效执法。卫生部最近启动了一项国家行动计划，并批准了一个多中心卫生改善项目，以加强越南抗菌剂管理的国家能力。这一分析为这些倡议提供了重要的投入。我们的方法和发现可能对世界上其他国家应对日益严重的抗生素耐药性威胁有所帮助。
Antimicrobial resistance is a major contemporary public health threat. Strategies to contain antimicrobial resistance have been comprehensively set forth, however in developing countries where the need for effective antimicrobials is greatest implementation has proved problematic. A better understanding of patterns and determinants of antibiotic use and resistance in emerging economies may permit more appropriately targeted interventions. Viet Nam, with a large population, high burden of infectious disease and relatively unrestricted access to medication, is an excellent case study of the difficulties faced by emerging economies in controlling antimicrobial resistance. Our working group conducted a situation analysis of the current patterns and determinants of antibiotic use and resistance in Viet Nam. International publications and local reports published between 1-1-1990 and 31-8-2012 were reviewed. All stakeholders analyzed the findings at a policy workshop and feasible recommendations were suggested to improve antibiotic use in Viet Nam. Here we report the results of our situation analysis focusing on: the healthcare system, drug regulation and supply; antibiotic resistance and infection control; and agricultural antibiotic use. Market reforms have improved healthcare access in Viet Nam and contributed to better health outcomes. However, increased accessibility has been accompanied by injudicious antibiotic use in hospitals and the community, with predictable escalation in bacterial resistance. Prescribing practices are poor and self-medication is common – often being the most affordable way to access healthcare. Many policies exist to regulate antibiotic use but enforcement is insufficient or lacking. Pneumococcal penicillin-resistance rates are the highest in Asia and carbapenem-resistant bacteria (notably NDM-1) have recently emerged. Hospital acquired infections, predominantly with multi-drug resistant Gram-negative organisms, place additional strain on limited resources. Widespread agricultural antibiotic use further propagates antimicrobial resistance. Future legislation regarding antibiotic access must alter incentives for purchasers and providers and ensure effective enforcement. The Ministry of Health recently initiated a national action plan and approved a multicenter health improvement project to strengthen national capacity for antimicrobial stewardship in Viet Nam. This analysis provided important input to these initiatives. Our methodologies and findings may be of use to others across the world tackling the growing threat of antibiotic resistance.
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DOI：
10.1016/j.ijantimicag.2012.01.002
发表时间：
2012-04-01
影响因子：
10.8
作者：
Kiratisin, Pattarachai;Chongthaleong, Anan;Davies, Todd
通讯作者：
Davies, Todd
影响因子：
3.7
作者：
Hoa NT;Chieu TT;Nghia HD;Mai NT;Anh PH;Wolbers M;Baker S;Campbell JI;Chau NV;Hien TT;Farrar J;Schultsz C
通讯作者：
Schultsz C
影响因子：
3.7
作者：
Dyar OJ;Hoa NQ;Trung NV;Phuc HD;Larsson M;Chuc NT;Lundborg CS
通讯作者：
Lundborg CS
影响因子：
2.7
作者：
Ha Nguyen;Wang, Wenjuan
通讯作者：
Wang, Wenjuan
1996 年至 2004 年越南耐喹诺酮肠炎沙门氏菌血清型 Typhi 的克隆扩增和微进化
影响因子：
9.4
作者：
Le, Thi Anh Hong;Fabre, Laetitia;Weill, Francois-Xavier
通讯作者：
Weill, Francois-Xavier