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新抗生素的发现、研究和开发:世卫组织耐抗生素细菌和结核病的优先名单

(2018-01-05 10:13:15)
分类: 学科热点
耐药性细菌的传播对世界范围内的发病率和死亡率构成重大威胁。由于其公共卫生和社会影响大,世卫组织一直认为耐多药结核病是全球投资新药的优先事项。2016,会员国要求世卫组织建立一个其他抗药性细菌优先名单,以支持研究和开发有效药物。
正是基于这样一个背景,这篇文章做出了一份细致严谨的研究,并于2017年12月21日发表于世界顶级医学杂志《The Lancet》。
以下是简介:

Discovery, research, and development of new antibiotics: the WHO priority list of antibiotic-resistant bacteria and tuberculosis

Prof Stephan Harbarth, MD
Prof Marc Mendelson, MD
Prof Céline Pulcini, MD
Prof Gunnar Kahlmeter, MD
Prof Jan Kluytmans, MD
Prof Yehuda Carmeli, MD
Prof Marc Ouellette, MD
Prof Kevin Outterson, JD
Prof Paul Hansen, PhD
Prof Nalini Singh, MD
 and the   
*Contributed equally
Members shown at end of paper
Minimise authors
Published: 21 December 2017

Summary

Background

The spread of antibiotic-resistant bacteria poses a substantial threat to morbidity and mortality worldwide. Due to its large public health and societal implications, multidrug-resistant tuberculosis has been long regarded by WHO as a global priority for investment in new drugs. In 2016, WHO was requested by member states to create a priority list of other antibiotic-resistant bacteria to support research and development of effective drugs.

Methods

We used a multicriteria decision analysis method to prioritise antibiotic-resistant bacteria; this method involved the identification of relevant criteria to assess priority against which each antibiotic-resistant bacterium was rated. The final priority ranking of the antibiotic-resistant bacteria was established after a preference-based survey was used to obtain expert weighting of criteria.

Findings

We selected 20 bacterial species with 25 patterns of acquired resistance and ten criteria to assess priority: mortality, health-care burden, community burden, prevalence of resistance, 10-year trend of resistance, transmissibility, preventability in the community setting, preventability in the health-care setting, treatability, and pipeline. We stratified the priority list into three tiers (critical, high, and medium priority), using the 33rd percentile of the bacterium's total scores as the cutoff. Critical-priority bacteria included carbapenem-resistant Acinetobacter baumannii and Pseudomonas aeruginosa, and carbapenem-resistant and third-generation cephalosporin-resistant Enterobacteriaceae. The highest ranked Gram-positive bacteria (high priority) were vancomycin-resistant Enterococcus faecium and meticillin-resistant Staphylococcus aureus. Of the bacteria typically responsible for community-acquired infections, clarithromycin-resistant Helicobacter pylori, and fluoroquinolone-resistant Campylobacter spp, Neisseria gonorrhoeae, and Salmonella typhi were included in the high-priority tier.

Interpretation

Future development strategies should focus on antibiotics that are active against multidrug-resistant tuberculosis and Gram-negative bacteria. The global strategy should include antibiotic-resistant bacteria responsible for community-acquired infections such as Salmonella spp, Campylobacter spp, N gonorrhoeae, and H pylori.

Funding

World Health Organization.

详情见链接:
http://www.thelancet.com/journals/laninf/article/PIIS1473-3099(17)30753-3/fulltext

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