Physician News (Integrated Media Reporter Huang Lingling) Antibacterial drugs have saved countless lives since their introduction in 1928, and are an important turning point in the long-term struggle for human survival and pathogenic bacteria. However, due to the overuse of antimicrobial drugs, bacterial resistance has become a major public health threat around the world.
If you ask a Critical Medicine DepartmentWhat situation are the patients most afraid of? Bacterial drug resistance and multidrug resistance must be one of them. Drug-resistant patients will have more difficulty in choosing antibacterial drugs and have a higher mortality rate. Therefore, in ICU, the mortality rate attributed to multi-drug resistant bacteria is increasing. Professor Yu Xiangyou from the Department of Critical Care Medicine, the First Affiliated Hospital of Xinjiang Medical University, said that this is also an important reason why we must emphasize curbing bacterial resistance and promote the rational application of antibacterial drugs.
implements cluster management Dealing with Multi-drug Resistance
Compared with other departments, the Department of Critical Care Medicine has always been responsible for the treatment of severe and critical diseases. The severity of the disease and various invasive medical technical operations, such as tracheal intubation, central venous catheterization, etc., will damage the human body barrier to a certain extent. In addition, patients have low immunity and are more prone to infection, so it is a department that uses a large amount of antibacterial drugs. "For multi-drug-resistant bacteria, we emphasize prevention over cure." Professor Yu Xiangyou pointed out that the thinking of prevention over cure has been throughout the entire process of anti-infective treatment.
The Department of Critical Care Medicine has always attached great importance to the prevention and control of hospital infections caused by "three tubes and one tube" (related infections caused by central venous catheters, endotracheal intubations, urinary catheters, and other indwelling tubes, and wound infections at surgical sites). Bundle management measures are fully applied in the Department of Critical Care Medicine. During the treatment process, aseptic operation, strict hand hygiene, isolation measures, etc. are all important measures for critical care medicine doctors to work hard to reduce the incidence of bacterial resistance. "It is really difficult to achieve zero, but as long as you work hard, you can always gain something."
In addition, empirical treatment is a commonly used method by doctors in the anti-infective treatment process. Professor Yu Xiangyou once encountered a kidney transplant patient who developed and problems 10 years after the kidney transplant and was preparing for a second kidney transplant. Unfortunately, the patient also suffered from viral pneumonia . Originally, his resistance was not as good as ordinary people. After he was combined with viral pneumonia, his health worsened. Later, secondary infections occurred during the treatment process. During the tracheal intubation and respiratory treatment, drug-resistant bacteria continued to appear. This poses a greater challenge to doctors, who must identify which bacteria are causing trouble. When the pathogenic bacteria have not yet been identified, doctors can only adopt empirical treatment methods to cover as many negative bacteria or positive bacteria and fungi as possible. Of course, it is also very important to submit specimens for examination in a timely manner and to find the real pathogenic bacteria through sputum culture, alveolar lavage fluid, blood culture, , etc. After the etiological results are obtained, the use of antibacterial drugs can be downgraded and replaced with more targeted treatments. This kidney transplant patient went through such a treatment process. Later, through metagenomic sequencing, the pathogen was found and the treatment was more precise.
Professor Yu Xiangyou emphasized that we must pay attention to tracing the origin of the pathogen . In fact, this saves time for treatment, improves efficiency, and avoids problems such as "accidental injury."
Contain drug resistance. Pay attention to multidisciplinary collaboration.
The country has been attacking hard to contain drug resistance. Recently, 13 departments jointly issued the "National Action Plan to Contain Microbial Resistance (2022-2025)". Professor Yu Xiangyou said that through the advancement of these national policies, the irrational use of antibacterial drugs in my country has dropped significantly, and the resistance of some bacteria has been effectively curbed, which can be said to be very effective.
The new action plan proposes to establish and improve the National Advisory Committee of Experts on Containing Microbial Resistance, promote communication and exchanges between experts in different fields and multi-disciplinary, provide decision-making consultation for strategic research and policy formulation, provide technical support for the implementation of the action plan, promptly propose adjustments to the action plan, and promote the improvement of relevant guidelines and technical specifications. This emphasizes the importance of multidisciplinary collaboration. Multiple disciplines include the Department of Critical Care Medicine, the Department of Infectious Diseases, the Department of Respiratory and Critical Care Medicine, the Department of Hematology, Surgery, and the Laboratory Department. The cooperation of these departments plays a vital role in curbing drug resistance. In particular, the Laboratory Department uses the latest metagenomic sequencing technology to shorten the detection of bacteria that previously took 5 days to 24 hours to produce results, which greatly improves the speed of testing, helps achieve more precise clinical treatment, and largely promotes the more rational application of antibacterial drugs.
Strict prevention and control measures are indispensable to reduce the incidence of CRE
It is worth mentioning that although the overall burden of antimicrobial drug use in my country is declining through the promotion of the country and the efforts of the medical community, the application of carbapenem antimicrobial drugs is increasing year by year. The number of carbapenem-resistant Enterobacteriaceae (CRE) and carbapenem-resistant Gram-negative rods (CRO) continues to grow. This type of high-level antibacterial drugs has a very broad antibacterial spectrum and strong bactericidal power. "If it is resistant to carbapenems, it will be considered a super-resistant bacteria and is very difficult to treat." Professor Yu Xiangyou said that because of the complex diseases in ICU, the higher level of medication, and the long medication time, it is inevitable that carbapenem resistance will occur. How does
reduce the incidence of CRE? Prevention and control measures in the ICU should also be strictly implemented, such as strict hand hygiene and aseptic operations, single-room isolation of drug-resistant bacteria, etc., to prevent their spread in the hospital to the greatest extent.
Of course, the rational application of antimicrobial drugs cannot be achieved only by the efforts of the Department of Critical Care Medicine. All specialties, even animal husbandry, and the entire society should be aware of the problem of antimicrobial drug abuse and work together on the use of antimicrobial drugs. Only in this way can we further promote the rational application of antimicrobial drugs and reduce the harm caused by antimicrobial drug abuse to the human body and the environment.
In recent years, the implementation of volume-based purchasing policies has reduced drug prices to a certain extent and brought real benefits to patients. However, one thing that needs to be emphasized is that the cheaper the drugs, the more they should be used rationally, especially antibacterial drugs. "Cheap does not mean that it can be used multiple times, and cheap does not mean that it can be abused." In addition, the quality requirements must be stricter and stricter to ensure quality and quantity. "We hope that the drugs purchased through large-scale procurement can have the same quality as some original drugs." Professor Yu Xiangyou pointed out that for the treatment of critically ill patients, there must be no delay at all. Sometimes, the accurate and timely, high-quality, and effective use of antibacterial drugs is an important factor in ensuring the success of patient treatment.
