Conducting Public Health Research Activities in Uzbekistan

抗菌素耐药性(AMR)目前被认为是威胁人类健康的主要全球健康问题 回到抗生素时代之前，可能会产生灾难性的社会和政治后果，特别是在 资源贫乏的国家。目前，AMR被定义为微生物对一种 最初有效治疗由它引起的感染的抗菌药被认为是一种 对健康的最大威胁。 虽然不是一个新现象，但AMR在最近几年已经成为一个更紧迫的问题，因为 大约70%的已知细菌对一种或多种抗生素产生了抗药性[1]。 据报道，一整类抗生素都出现了耐药性，并且出现了无法治愈的多重耐药性。 细菌越来越多地被记录在案[2]。随着微生物越来越多地沉浸在 有利于AMR存在的环境导致从头抵抗或遗传转移 在它们之间编码的抗药性，影响抗药性的进化力量似乎一直存在。 然而，有一些可控的做法可以加快其获得抗性基因的速度。这些 包括抗生素使用不当和滥用(过度或不合理地用于治疗和预防)， 不合标准的可用性。药物(特别是在抗生素含量较低的低收入国家 受控)，全球旅行和医疗旅游增加，新产品研发下降 药物、感染控制措施应用不力以及抗生素在农业中的使用 行业[3]。 恶性疟原虫是最危险的疟疾寄生虫，它已经对 东南亚部分地区目前几乎所有可用的抗疟疾药物。零星病例 大流行H1N1流感对奥司他韦表现出抗药性，奥司他韦是仅有的两种抗病毒药物之一。 在美国，耐甲氧西林金黄色葡萄球菌，又称MRSA，在许多情况下都是一个问题 医疗保健设置。耐药肺炎克雷伯氏菌，以前在有限数量的 医院，现在至少有36个州报告了这一事件。淋病奈瑟菌现在对 1 头孢菌素是治疗这种常见性行为的唯一推荐类别的抗菌药 传播感染。不动杆菌属。对以前成功使用的抗菌剂产生抗药性的药物现在 影响战地军事人员的公认病原体[4]。 在低收入国家和中等收入国家，涉及AMR的数据明显较差。 有证据表明，在这些国家，70%的医疗相关感染很难治疗。 由于对一线抗生素的耐药性和多重耐药性，ILAS迫使临床医生求助于 二线和三线治疗反过来又增加了成本[5]。耐药性的影响是显而易见的 不仅在对人类健康的影响上，而且在潜在的沉重的经济代价和 在国家和全球范围内动员政治行动应对这一问题的困难。主要的政治 缺乏表明抗生素耐药性不会造成成本的准确经济估计 在以证据为基础的政策制定方面足够多，足以被赋予其应有的优先地位[6]。 对乌兹别克斯坦和中亚其他四个国家AMR的流行情况知之甚少 区域(汽车)。尽管质量经常不确定，但关于汽车AMR的稀少信息描述了 抵抗是一种常见的现象。耐多药结核病(MDR-TB)已成为 乌兹别克斯坦结核病控制面临的主要威胁强化了这一信念。在世界项目第四次报告中 耐多药结核病，耐多药结核病的最高患病率(60%)发现在乌兹别克斯坦首都塔什干[7]。 根据在乌兹别克斯坦进行的几项研究的结果，目前90%的志贺氏菌临床菌株 福氏杆菌(乌兹别克斯坦志贺氏菌病的主要原因)，已对氨苄西林失去敏感性， 氯霉素和四环素[8]。另一项研究报告伤寒沙门氏菌菌株为 对氨苄西林和四环素具有多重耐药性[9]。 公共卫生当局2012年进行的试点调查显示，31%的医生在 乌兹别克斯坦开抗生素治疗呼吸道病毒感染50%的患者服用抗生素 在家，35%的人在没有咨询医生的情况下开始服用抗生素。 乌兹别克斯坦的主要问题之一是普遍存在的在柜台上销售抗生素的做法 在没有处方的情况下，很容易过度使用和误用抗生素。作为一种药物 在生产国，由于可获得不合格的药物，仍然存在对药物安全的重大担忧 以及乌兹别克斯坦药店的假药。2007年，乌兹别克斯坦跻身前十名 根据药物安全研究所报告假药事件的国家[10]。 2013年11月，世卫组织-欧洲AMR评估小组访问了塔什干，以便(1)获得 了解国家和部门间协调以执行对抗行动的状况 AMR；(2)评估国家AMR监测状况；和(3)讨论技术要求 加入了AMR监测和抗生素敏感性测试的国际网络。 根据AMR评估团的结果提供的建议，以下 将在项目执行期间审议拟议的行动：(1)确定对以下问题的认识 在一般人群和目标人群中进行AMR；(2)实施AMR监测和监测 抗菌剂消费；和(3)支持应对这一威胁的国家计划和战略 由AMR根据2011年欧洲抗生素耐药性战略行动计划提出 (谁是欧元。Memoire AMR使团-塔什干，乌兹别克斯坦。2014年6月6日。个人通信)。

Antimicrobial resistance (AMR) is currently recognized as a major global health problem that threatens a return to the pre-antibiotic era with potentially catastrophic social and political ramifications especially in resource-poor countries. Currently, AMR, defined as the resistance of a microorganism to an antimicrobial drug that was originally effective for treatment of infections caused by it, is considered one of the greatest threats to health. Although not a new phenomenon, AMR has become a more pressing issue over recent years as approximately 70% of known bacteria have developed resistance to one or more antibiotics [1]. Resistance has been reported for an entire class of antibiotics and untreatable, multi-drug resistance bacteria are increasingly being documented [2]. As microorganisms are increasingly immersed in environments that favor the existence of AMR leading to de novo resistance or transfer of genetically encoded resistance among themselves, the evolutionary forces affecting resistance seem ever present. There are, however, controllable practices that accelerate its acquisition of resistance genes. These include poor use and abuse of antibiotics (excessive or irrational use for treatment and prevention), availability of substandard. drugs (especially in low-income countries where antibiotics are poorly controlled), increased global travel and medical tourism, declines in research and development for new medicines, poor application of infection control measures, and use of antibiotics in the agricultural industry [3]. Plasmodium falciparum, the most dangerous of the malaria parasites, has developed resistance to nearly all of the currently available antimalarial drugs in parts of Southeast Asia. Sporadic cases of pandemic H1 N1 flu have shown resistance to oseltamivir, one of only two antivirals that work against it. In the United States, methicillin-resistant Staphylococcus aureus, known as MRSA, is a problem in many health care settings. Drug-resistant Klebsiella pneumoniae, previously seen in a limited number of hospitals, has now been reported in at least 36 states. Neisseria gonorrheae is now resistant to 1 cephalosporins, the only recommended class of antimicrobials left to treat this common sexually transmitted infection. Acinetobacter spp. resistant to previously successfully used antimicrobials are now well recognized pathogens affecting military staff in the fields [4]. Data addressing AMR are significantly poor in low- and middle-income countries income countries. Evidence suggests that 70% of healthcare associated infections in these countries are difficult to treat due to resistance to first-line antibiotics and multi-drug resistance Ilas forced clinicians to fall back on second- and third- line treatments which in turn multiplies costs [5]. The effects of resistance manifest themselves not just in the impact on human health, but also in potentially heavy economic costs and difficulties in mobilizing political action to deal with it, nationally and globally. The main political ramification is the dearth of accurate economic estimates indicating antibiotic resistance does not cost enough in evidence-based policy-making to be assigned the priority it deserves [6]. Little is known about prevalence of AMR in Uzbekistan and the other four countries of the Central Asia Region (CAR). Although often of uncertain quality, the scant information on AMR in CAR describes resistance as a common phenomenon. Multidrug-resistant tuberculosis (MDR-TB) has emerged as a major threat to TB control in Uzbekistan reinforces this belief. In the fourth report of the World Project on MDR-TB, the highest prevalence (60%) of MDR-TB was found in Tashkent, the capital of Uzbekistan [7]. Based on results of several studies performed in Uzbekistan, currently, 90% of clinical strains of Shigella flexneri (major cause of shigellosis in Uzbekistan), have lost their sensitivity to ampicillin, chloramphenicol (levomycetin) and tetracycline [8]. Another study reported Salmonella typhi strains as being multidrug-resistant to ampicillin and tetracycline [9]. The 2012 pilot survey performed by public health authorities revealed that 31 % of the doctors in Uzbekistan prescribe antibiotics to treat respiratory viral infections, 50% patients have antibiotics at home, and 35 % start taking antibiotics without consulting with a doctor. One of the main problems in Uzbekistan is the widespread practice of selling antibiotics over the counter without a prescription making the overuse and misuse of antibiotics easy. As a pharmaceutical producing country, there are still major concerns about drug safety, due to the availability of substandard and counterfeit drugs in Uzbek pharmacies. In 2007, Uzbekistan was one of the top ten countries reporting counterfeit drug incidents according to the Pharmaceutical Security Institute [10]. In November 2013, the WHO-EURO AMR assessment team visited Tashkent in order to (i) gain an understanding of the status of national and intersectoral coordination to implement actions to counteract AMR; (ii) to assess the status of national AMR surveillance; and (iii) to discuss technical requirements for joining an international network for AMR surveillance, and antibiotic susceptibility testing. Following the provided recommendations from the AMR assessment mission's results, the following proposed actions will be considered during the project implementation period: (i) identify awareness for AMR in the general and in targeted populations; (ii) implement AMR surveillance and surveillance of antimicrobial consumption; and (iii) support to national plans and strategies to counteract the threat posed by AMR, in accordance with the 2011 European Strategic Action Plan on Antibiotic Resistance (WHO EURO. Aide-Memoire AMR Mission - Tashkent, Uzbekistan. 6.6.2014. Personal communication).