Conducting Public Health Research Activities in Uzbekistan

在乌兹别克斯坦开展公共卫生研究活动

• 批准号: 9133148
• 负责人: Abdurashid Abdushukurov
• 金额: $ 19.94万
• 依托单位: SRIEMCD MOH UZB
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-09-15 至 2020-09-14
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9133148
• 关键词: Conducting; Public; Health; Research; Activities

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).

抗菌素耐药性（AMR）目前被认为是一个主要的全球健康问题，威胁着人类的健康。 回到前抗生素时代，可能带来灾难性的社会和政治后果，特别是在 资源贫乏的国家。目前，耐药性被定义为微生物对抗生素的耐药性。 最初有效治疗由其引起的感染的抗微生物药物被认为是一种 对健康的最大威胁。 虽然不是一个新现象，但AMR近年来已成为一个更加紧迫的问题， 大约70%的已知细菌已经对一种或多种抗生素产生了耐药性[1]。 据报道，耐药性已对整个类别的抗生素和无法治愈的，多药耐药性 细菌越来越多地被记录下来[2]。随着微生物越来越多地浸入 有利于AMR存在的环境，导致从头耐药或遗传转移， 在它们之间编码的抵抗力中，影响抵抗力的进化力量似乎永远存在。 然而，有一些可控的做法可以加速其获得抗性基因。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）， 可用性低于标准。药物（特别是在抗生素缺乏的低收入国家） 控制），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当，以及农业中使用抗生素， 工业[3]。 恶性疟原虫是最危险的疟疾寄生虫， 在东南亚部分地区，几乎所有目前可用的抗疟疾药物。散发病例 大流行性H1N1流感已经显示出对奥司他韦的耐药性，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（MRSA）是许多国家的一个问题， 卫生保健机构。耐药肺炎克雷伯菌，以前在有限数量的 据报道，目前至少有36个州的医院发生了这种情况。淋病奈瑟菌现在对 1 头孢菌素，唯一推荐的抗生素类左治疗这种常见的性 传播感染。不动杆菌属对以前成功使用的抗菌药物的耐药性现在 影响战地军事人员的公认病原体[4]。 在低收入和中等收入国家，关于抗生素耐药性的数据非常少。 有证据表明，这些国家70%的医疗保健相关感染难以治疗 由于对一线抗生素的耐药性和多重耐药性，Ilas迫使临床医生依靠 二线和三线治疗，这反过来又会增加成本[5]。抵抗的影响表现在 不仅对人类健康的影响，而且潜在的巨大经济成本， 在国家和全球范围内动员政治行动解决这一问题的困难。主要政治 分歧是缺乏准确的经济估计，表明抗生素耐药性不会造成成本 在基于证据的决策中有足够的证据，以获得应有的优先考虑[6]。 关于乌兹别克斯坦和其他四个中亚国家的AMR患病率知之甚少 区域（CAR）。尽管质量往往不确定，但CAR中AMR的信息很少， 阻力是一种普遍现象。耐多药结核病（MDR-TB）已成为一种 乌兹别克斯坦结核病控制面临的重大威胁强化了这一信念。在世界项目第四次报告中， 在乌兹别克斯坦首都塔什干发现了耐多药结核病，其最高流行率（60%）[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），已经失去了对氨苄青霉素的敏感性， 氯霉素（左旋霉素）和四环素[8]。另一项研究报告伤寒沙门氏菌菌株， 对氨苄青霉素和四环素具有多重耐药[9]。 公共卫生当局2012年进行的试点调查显示， 乌兹别克斯坦处方抗生素治疗呼吸道病毒感染，50%的患者使用抗生素 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在柜台上出售抗生素的普遍做法 没有处方，容易滥用抗生素。作为药物 在生产国，由于可获得不合格的药品， 乌兹别克斯坦药店的假药2007年，乌兹别克斯坦是前十名之一 根据药品安全研究所报告的假药事件的国家[10]。 2013年11月，世卫组织-欧洲抗生素耐药性评估小组访问了塔什干，目的是（i）获得 了解国家和部门间协调开展行动， （ii）评估国家抗生素耐药性监测状况;（iii）讨论技术要求 加入AMR监测和抗生素敏感性测试的国际网络。 根据AMR评估使命结果提供的建议， 在项目执行期间将考虑拟议的行动： 一般人群和目标人群中的AMR;（ii）实施AMR监测， （iii）支持应对这一威胁的国家计划和战略 根据2011年欧洲抗生素耐药性战略行动计划，由耐药性抗生素引起 (WHO欧元.乌兹别克斯坦塔什干AMR使命备忘录。6.6.2014.个人通信）。