新闻周刊:对抗耐药菌(9)(在线收听

Slowing the Superbugs

减缓超级细菌

Although the pharmaceutical industry has all but abandoned antibiotics, researchers haven't given up hope of finding new ones. The antibiotic revolution was kicked off in 1928, when Alexander Fleming returned from vacation to his London lab only to find a weird-looking mold growing in a dish he had left by an open window. Ever since, researchers have tried to peek into every corner of nature for the next great bacteria-killer. According to recent studies, among the new sources of substances that appear lethal to even resistant bacteria—yet may be safe for human consumption—are insects, seaweed, the mucus on young fish, arsenic-rich dirt in Ireland and even Martian soil. One team at Leiden University in the Netherlands is trying to build an artificial bacterium from scratch in hopes it can be tweaked to manufacture a new antibiotic.

尽管制药行业几乎已经放弃了抗生素,但研究人员并没有放弃寻找新抗生素的希望。抗生素革命始于1928年,当时度假归来的亚历山大?弗莱明在伦敦的实验室里发现了一种奇怪的霉菌。从那以后,研究人员一直试图深入自然界的每一个角落,寻找下一个伟大的细菌杀手。根据最近的研究,在一些新的物质来源中,昆虫、海藻、小鱼身上的黏液、爱尔兰富含砷的泥土,甚至是火星土壤,这些物质即使对具有抗药性的细菌来说也是致命的,但对人类来说可能是安全的。荷兰莱顿大学的一个研究小组正在尝试从无到有地制造一种人工细菌,希望能对其进行微调,从而制造出一种新的抗生素。

Doctors are also trying to make the best use of antibiotics we have now by slowing the development of new resistant strains. That calls for cutting back on rampant overuse of antibiotics, which encourages superbugs to evolve. Doing so has to become an international effort, because the resistant bugs in one part of the world often made their way from elsewhere.

医生们还试图通过减缓新的耐药菌株的发展来最大限度地利用我们现有的抗生素。这就要求减少抗生素的过度使用,因为过度使用会促使超级细菌进化。这样做必须成为一项国际性的努力,因为世界上某一地区的抗药性细菌往往是从其他地方传播过来的。

Developing countries are becoming a particularly frequent source for emergent bacterial threats that end up in the U.S., notes UConn's Banach. Studies have found that in most of the world antibiotics are readily dispensed from community pharmacies without prescriptions, contributing to a 65 percent climb in global antibiotic use between 2000 and 2015. The resulting resistant bugs skip frictionlessly around the world in the guts of millions of international travelers. “The impact of antibiotic overuse in these countries, as well as living and environmental conditions, are facilitating the worldwide spread of resistant organisms,” he says.

康州大学的巴拿赫指出,发展中国家正成为最终出现在美国的突发细菌威胁的一个特别频繁的来源。研究发现,在世界上大多数地方,抗生素很容易在没有处方的情况下从社区药店配药,这使得2000年至2015年间全球抗生素使用量上升了65%。由此产生的耐药细菌在全球数百万国际旅行者的肠道内无摩擦地跳过。“这些国家抗生素过度使用的影响,以及生活和环境条件,正在促进耐药生物在世界范围内的传播,”他表示。

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Patients have a role to play too. Pressuring doctors to prescribe antibiotics for mild congestion, urinary tract infections or slow-to-heal wounds contributes to antibiotic overuse and the resulting resistance. Massachusetts public health officials have been pushing physicians and the public to ease up on antibiotics for more than a decade, and the state was rewarded with a 16 percent drop in prescriptions over a four-year period. A small victory, perhaps, in a large war that we have so far been mostly losing.

病人也有责任。对医生施加压力,要求医生为轻度充血、尿路感染或伤口愈合缓慢开抗生素处方,这导致了抗生素的过度使用和由此产生的耐药性。十多年来,马萨诸塞州的公共卫生官员一直在敦促医生和公众减少抗生素的使用,在四年的时间里,该州的处方量减少了16%。也许,在一场我们到目前为止几乎已经输掉的大战中,这是一场小小的胜利。

The cost of our failure to act a decade or more ago to this easily foreseeable crisis will most likely be a spreading tide of severe illness and death. It won't rise to the level of deadly mass outbreak the way a killer virus like Ebola could. But resistant infections will begin to affect more and more of us. Even if medicine, government and industry embarked today on a massive effort to find new approaches to combat resistant infections like the Columbia E. coli —which they aren't close to doing—the payoff wouldn't come for a decade or more.

十多年前,我们未能对这场容易预见的危机采取行动,其代价很可能是严重疾病和死亡的蔓延。它不会像埃博拉这样的致命病毒那样大规模爆发。但是耐药感染将开始影响越来越多的人。即使医药、政府和工业界从今天开始就大规模努力寻找新的方法来对抗耐药感染,如哥伦比亚大肠杆菌(对抗这种细菌还有很长的路要走),成果回报也要等到十年后甚至更久。

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