India facing a pandemic of antibiotics-resistant superbugsÇ×»ýÁ¦ ³»¼º ½´ÆÛ¹ö±×ÀÇ ´ëÀ¯Çà¿¡ Á÷¸éÇÑ Àεµ[BBC] 2022. 10. 11
At the 1,000-bed not-for-profit Kasturba Hospital in the western Indian state of Maharashtra, doctors are grappling with a rash of antibiotic-resistant "superbug infections".Àεµ ¼ºÎ ¸¶Ç϶ó½´Æ®¶ó ÁÖ¿¡ ÀÖ´Â 1,000°³ÀÇ º´»óÀ» °®Ãá ºñ¿µ¸® Ä«½ºÅõ¸£¹Ù º´¿ø¿¡¼ ÀÇ»çµéÀº Ç×»ýÁ¦ ³»¼º "½´ÆÛ¹ö±× °¨¿°"ÀÇ ¹ßÁø°ú ¾¾¸§ÇÏ°í ÀÖ´Ù.This happens when bacteria change over time and become resistant to drugs that are supposed to defeat them and cure the infections they cause.ÀÌ°ÍÀº ¹ÚÅ׸®¾Æ°¡ ½Ã°£ÀÌ Áö³²¿¡ µû¶ó º¯ÇÏ°í ±×µéÀ» ¹°¸®Ä¡°í ±×µéÀÌ ¾ß±âÇÏ´Â °¨¿°À» Ä¡·áÇØ¾ß ÇÏ´Â ¾à¿¡ ³»¼ºÀÌ »ý±æ ¶§ ÀϾÙ.Such resistance directly caused 1.27 million deaths worldwide in 2019, according to The Lancet, a medical journal. Antibiotics - which are considered to be the first line of defence against severe infections - did not work on most of these cases.ÀÇÇÐÀú³Î ·£½Ë¿¡ µû¸£¸é ÀÌ·¯ÇÑ ÀúÇ×Àº 2019³â Àü ¼¼°èÀûÀ¸·Î 127¸¸ ¸íÀÌ »ç¸ÁÇß´Ù. ½É°¢ÇÑ °¨¿°¿¡ ´ëÇÑ Ã¹ ¹ø° ¹æ¾î¼±À¸·Î ¿©°ÜÁö´Â Ç×»ýÁ¦´Â ´ëºÎºÐÀÇ °æ¿ì¿¡ È¿°ú°¡ ¾ø¾ú´Ù.Millions are dying from drug-resistant infections¼ö¹é¸¸ ¸íÀÌ ¾à¹° ³»¼º °¨¿°À¸·Î »ç¸ÁÇÏ°í ÀÖ´Ù.Tests carried out at Kasturba Hospital to find out which antibiotic would be most effective in tackling five main bacterial pathogens have found that a number of key drugs were barely effective.5°³ÀÇ ÁÖ¿ä ¹ÚÅ׸®¾Æ º´¿ø±ÕÀ» ´Ù·ç´Âµ¥ ¾î¶² Ç×»ýÁ¦°¡ °¡Àå È¿°úÀûÀÎÁö ¾Ë¾Æº¸±â À§ÇØ Ä«½ºÅõ¸£¹Ù º´¿ø¿¡¼ ½Ç½ÃÇÑ ½ÇÇèÀº ¸¹Àº ÁÖ¿ä ¾à¹°µéÀÌ °ÅÀÇ È¿°ú°¡ ¾ø´Ù´Â °ÍÀ» ¹ß°ßÇß´Ù.These pathogens include E.coli (Escherichia coli), commonly found in the intestines of humans and animals after consumption of contaminated food; Klebsiella pneumoniae, which can infect the lungs to cause pneumonia, and the blood, cuts in the skin and the lining of the brain to cause meningitis; and the deadly Staphylococcus aureus, a food-borne bacteria that can be transmitted through air droplets or aerosols.ÀÌ º´¿ø±Õ¿¡´Â ¿À¿° µÈ À½½ÄÀ» ¼·Ãë ÇÑ ÈÄ »ç¶÷°ú µ¿¹°ÀÇ Àå¿¡¼ ÈçÈ÷ ¹ß°ßµÇ´Â ´ëÀå±ÕÀÌ Æ÷ÇԵ˴ϴÙ. Æó·ÅÀ» ÀÏÀ¸Å°±â À§ÇØ Æó¸¦ °¨¿°½Ãų ¼öÀÖ´Â Æó·Å°£±Õ Ç÷¾×ÀÌ ³úÀÇ ÇÇºÎ¿Í ¾È°¨À» Àý´ÜÇÏ¿© ¼ö¸·¿°À» ÀÏÀ¸Å³ ¼ö ÀÖ½À´Ï´Ù. °ø±â ¹æ¿ïÀ̳ª ¿¡¾î·ÎÁ¹À» ÅëÇØ Àü¿° µÉ ¼öÀÖ´Â Ä¡¸íÀûÀÎ Æ÷µµ»ó ±¸±ÕÀÌ ÀÖ½À´Ï´Ù.Doctors found that some of the main antibiotics were less than 15% effective in treating infections caused by these pathogens. Most concerning was the emergence of the multidrug-resistant pathogen called Acinetobacter baumannii, which attacks the lungs of patients on life support in critical care units.ÀÇ»çµéÀº ÁÖ¿ä Ç×»ýÁ¦ Áß ÀϺΰ¡ ÀÌ·¯ÇÑ º´¿ø±Õ¿¡ ÀÇÇÑ °¨¿°À» Ä¡·áÇϴµ¥ 15% ¹Ì¸¸ÀÇ È¿°ú°¡ ÀÖ´Ù´Â °ÍÀ» ¹ß°ßÇß´Ù. °¡Àå ¿ì·ÁµÇ´Â °ÍÀº ÁßȯÀڽǿ¡¼ »ý¸íÀ¯ÁöÀåÄ¡·Î ȯÀÚÀÇ Æó¸¦ °ø°ÝÇÏ´Â ¾Æ½Ã³×Åä¹ÚÅÍ ¹Ù¿ì¸¶´Ï¶ó°í ºÒ¸®´Â ´ÙÁ¦³»¼º º´¿ø±ÕÀÇ ÃâÇöÀ̾ú´Ù.Hidden pandemic of antibiotic-resistant infectionsÇ×»ýÁ¦ ³»¼º °¨¿°ÀÇ ¼û°ÜÁø Àü¿°º´"As almost all our patients cannot afford the higher antibiotics, they run the real risk of dying when they develop ventilator-associated pneumonia in the ICU," Dr SP Kalantri, medical superintendent of the hospital, says."°ÅÀÇ ¸ðµç ȯÀÚµéÀÌ ´õ ³ôÀº Ç×»ýÁ¦¸¦ »ì ¿©À¯°¡ ¾ø±â ¶§¹®¿¡, ±×µéÀº ÁßȯÀڽǿ¡¼ ÀΰøÈ£Èí±â °ü·Ã Æó·Å¿¡ °É·ÈÀ» ¶§ »ç¸ÁÇÒ À§ÇèÀÌ ÀÖ½À´Ï´Ù,"¶ó°í ÀÌ º´¿øÀÇ ÀÇ·á °¨µ¶°üÀÎ SP Ä®¶õÆ®¸® ¹Ú»ç´Â ¸»ÇÑ´Ù.
A new report by Indian Council of Medical Research (ICMR) says that resistance to a powerful class of antibiotics called carbapenems - it defeats a number of pathogens - had risen by up to 10% in just one year alone. The report collects data on antibiotic resistance from up to 30 public and private hospitals every year.Àεµ ÀÇÇÐ ¿¬±¸À§¿øȸÀÇ »õ·Î¿î º¸°í¼¿¡ µû¸£¸é Ä«¹Ù Æä³Û À̶ó´Â °·ÂÇÑ Ç×»ýÁ¦¿¡ ´ëÇÑ ³»¼ºÀº 1³â ¸¸¿¡ 10%±îÁö Áõ°¡Çß½À´Ï´Ù. ÀÌ º¸°í¼´Â ¸Å³â ÃÖ´ë 30°³ÀÇ °ø¸³ ¹× »ç¸³ º´¿øÀÇ Ç×»ýÁ¦ ³»¼º¿¡ ´ëÇÑ ÀڷḦ ¼öÁýÇÏ°í ÀÖ´Ù."The reason why this is alarming is that it is a great drug to treat sepsis [a life-threatening condition] and sometimes used as a first line of treatment in hospitals for very sick patients in ICUs," says Dr Kamini Walia, a scientist at Indian Council of Medical Research (ICMR) and lead author of the study."ÀÌ°ÍÀÌ ³î¶ó¿î ÀÌÀ¯´Â ÆÐÇ÷Áõ (»ý¸íÀ» À§ÇùÇÏ´Â »óÅÂ)À» Ä¡·áÇÒ ¼öÀÖ´Â ÈǸ¢ÇÑ ¾à¹°ÀÌ¸ç ¶§·Î´Â ÁßȯÀÚ ½Ç¿¡¼ ¸Å¿ì ¾ÆÇ ȯÀÚ¸¦ À§ÇÑ º´¿ø¿¡¼ÀÇ Ã¹ ¹ø° Ä¡·á¹ýÀ¸·Î »ç¿ëµÇ±â ¶§¹®ÀÔ´Ï´Ù."¶ó°í Àεµ ÀÇÇÐ ¿¬±¸À§¿øȸ (ICMR)ÀÇ °úÇÐÀÚ ÀÎ Ä«¹Ì´Ï ¿Ð¸®¾Æ ¹Ú»ç´Â ¸»ÇÕ´Ï´Ù.Things are so worrying that only 43% of the pneumonia infections caused by one pathogen in India could be treated with first line of antibiotics in 2021, down from 65% in 2016, the ICMR report says.Àεµ¿¡¼ ÇÑ º´¿ø±Õ¿¡ ÀÇÇÑ Æó·Å °¨¿°ÀÇ 43%¸¸ÀÌ 2016³âÀÇ 65%¿¡¼ 2021³â¿¡ Ç×»ýÁ¦ÀÇ Ã¹ ¹ø° ¶óÀÎÀ¸·Î Ä¡·á µÉ ¼ö ÀÖ´Ù°í ICMR º¸°í¼´Â ¹àÇû½À´Ï´Ù.Saswati Sinha, a critical care specialist in AMRI Hospital in the eastern city of Kolkata, says things are so bad that "six out of 10" patients in her ICU have drug-resistant infections. "The situation is truly alarming. We have come to a stage where you are not left with too many options to treat some of these patients."ÄÝīŸ µ¿ºÎÀÇ AMRI º´¿øÀÇ ÁßȯÀÚ Ä¡·á Àü¹®°¡ÀÎ »ç½º¿ÍƼ ½ÅÇÏ´Â ÁßȯÀڽǿ¡ ÀÖ´Â "10¸í Áß 6¸í"ÀÇ È¯ÀÚµéÀÌ ¾à¹° ³»¼º °¨¿°À» ÀÏÀ¸Å³ Á¤µµ·Î »óȲÀÌ ½É°¢ÇÏ´Ù°í ¸»ÇÑ´Ù. "»óȲÀÌ Á¤¸» ½É°¢ÇÕ´Ï´Ù. ¿ì¸®´Â ÀÌ È¯ÀÚµé Áß ÀϺθ¦ Ä¡·áÇÒ ¼ö ÀÖ´Â ¸¹Àº ¿É¼ÇÀÌ ¾ø´Â ´Ü°è¿¡ µµ´ÞÇß½À´Ï´Ù. "What would a world without antibiotics be like?Ç×»ýÁ¦°¡ ¾ø´Â ¼¼»óÀº ¾î¶² ¸ð½ÀÀϱî?Resistance to antibiotics, say doctors at Kasturba Hospital, is widespread even among outpatients from villages and small towns with conditions such as pneumonia and urinary tract infections. Since most don't carry prescriptions and can't recall the drugs they were prescribed, doctors find it difficult to get records of their past exposure to antibiotics.Ä«½ºÅõ¸£¹Ù º´¿øÀÇ ÀÇ»çµéÀº Æó·Å°ú ¿ä·Î °¨¿°°ú °°Àº ÁúȯÀÌ ÀÖ´Â ¸¶À»°ú ÀÛÀº ¸¶À»ÀÇ ¿Ü·¡È¯ÀÚµé »çÀÌ¿¡¼µµ Ç×»ýÁ¦¿¡ ´ëÇÑ ÀúÇ×ÀÌ ³Î¸® ÆÛÁ® ÀÖ´Ù°í ¸»ÇÑ´Ù. ´ëºÎºÐÀº ó¹æÀüÀ» ¼ÒÁöÇÏÁö ¾Ê°í ó¹æ¹ÞÀº ¾àÀ» ±â¾ïÇÏÁö ¸øÇϱ⠶§¹®¿¡ ÀÇ»çµéÀº Ç×»ýÁ¦¿¡ ´ëÇÑ ±â·ÏÀ» ¾ò±â°¡ ¾î·Æ½À´Ï´Ù.Managing such patients is an ordeal. "The situation is desperate, and desperate measures - ordering more and more antibiotics is likely to result in more harm than benefits," says Dr Kalantri.±×·± ȯÀÚµéÀ» °ü¸®ÇÏ´Â °ÍÀº ½Ã·ÃÀÌ´Ù. Ä®¶õÆ®¸® ¹Ú»ç´Â "»óȲÀº Àý¹ÚÇϸç, Á¡Á¡ ´õ ¸¹Àº Ç×»ýÁ¦¸¦ ÁÖ¹®ÇÏ´Â °ÍÀº ÀÌÀͺ¸´Ù ´õ Å« Çظ¦ ³¢Ä¥ °¡´É¼ºÀÌ ÀÖ´Ù"°í ÇÑ´Ù.Public health experts believe many doctors in India prescribe antibiotics indiscriminately.°øÁß º¸°Ç Àü¹®°¡µéÀº ÀεµÀÇ ¸¹Àº ÀÇ»çµéÀÌ Ç×»ýÁ¦¸¦ ¹«Â÷º°ÀûÀ¸·Î ó¹æÇÑ´Ù°í ¹Ï°í ÀÖ´Ù.
Antibiotics, for example, cannot cure viral illnesses like flu or common cold. Patients with dengue - a viral infection - and malaria - caused by a single-celled parasite - often receive antibiotics. Antibiotics continue to be prescribed for diarrheal diseases and upper respiratory infections for which they have limited value.¿¹¸¦ µé¾î, Ç×»ýÁ¦´Â µ¶°¨À̳ª ÀÏ¹Ý °¨±â¿Í °°Àº ¹ÙÀÌ·¯½º¼º Áúº´À» Ä¡·áÇÒ ¼ö ¾ø´Ù. ´Ü¼¼Æ÷ ±â»ýÃæ¿¡ ÀÇÇÑ µ±â¿°ú ¸»¶ó¸®¾Æ ȯÀÚµéÀº Á¾Á¾ Ç×»ýÁ¦¸¦ ¹Þ´Â´Ù. Ç×»ýÁ¦´Â Á¦ÇÑµÈ °¡Ä¡¸¦ Áö´Ñ ¼³»ç Áúȯ ¹× »ó±âµµ °¨¿°¿¡ ´ëÇØ °è¼Ó ó¹æµË´Ï´Ù.During the chaotic treatment of Covid-19, patients were treated with antibiotics which resulted in more adverse effects. Last year, a ICMR study of 17,534 Covid-19 patients in Indian hospitals found that more than half of them who acquired drug-resistant infections died.Äڷγª19ÀÇ È¥¶õ½º·¯¿î Ä¡·á °úÁ¤¿¡¼ ȯÀÚµéÀº Ç×»ýÁ¦·Î Ä¡·á¸¦ ¹Þ¾Ò°í, ÀÌ·Î ÀÎÇØ ´õ ¸¹Àº ºÎÀÛ¿ëÀÌ ¹ß»ýÇß´Ù.Áö³ÇØ Àεµ º´¿øÀÇ Äڷγª19ȯÀÚ 1¸¸7534¸íÀ» ´ë»óÀ¸·Î ÇÑ ICMR ¿¬±¸¿¡¼´Â ¾à¹° ³»¼º °¨¿°¿¡ °É¸° ȯÀÚÀÇ Àý¹Ý ÀÌ»óÀÌ »ç¸ÁÇÑ °ÍÀ¸·Î ³ªÅ¸³µ´Ù.Yet prescriptions for broad-spectrum antibiotics - drugs that should be reserved for tackling the most serious, hard-to-treat bacterial infections - comprise a whopping 75% of all prescriptions issued in India's hospitals, studies have found.±×·¯³ª °¡Àå ½É°¢ÇÏ°í Ä¡·áÇϱ⠾î·Á¿î ¹ÚÅ׸®¾Æ °¨¿°¿¡ ´ëóÇϱâ À§ÇØ ³²°Ü µÎ¾î¾ßÇÏ´Â ±¤¹üÀ§ Ç×»ýÁ¦ ó¹æÀº Àεµ º´¿ø¿¡¼ ¹ßÇà µÈ ¸ðµç ó¹æÀüÀÇ 75%¸¦ Â÷ÁöÇÏ´Â °ÍÀ¸·Î ³ªÅ¸³µ½À´Ï´Ù.To be true, doctors are not to blame entirely. In large, crowded public hospitals, they are starved of time of see patients, diagnose their illnesses, sort bacterial from viral diseases and design treatment plans, says Dr Kalantri.»ç½Ç, ÀÇ»çµéÀº ÀüÀûÀ¸·Î Ã¥ÀÓÀÌ ¾ø½À´Ï´Ù. Å©°í ºÕºñ´Â °ø¸³ º´¿ø¿¡¼´Â ȯÀÚ¸¦ º¸°í, º´À» Áø´ÜÇÏ°í, ¹ÙÀÌ·¯½º Áúȯ¿¡¼ ¹ÚÅ׸®¾Æ¸¦ ºÐ·ùÇÏ°í, Ä¡·á °èȹÀ» ¼³°èÇÒ ½Ã°£ÀÌ ºÎÁ·ÇÏ´Ù°í Ä®¶õÆ®¸® ¹Ú»ç´Â ¸»ÇÑ´Ù.A widespread lack of knowledge about antibiotics means that most patients - rural and urban - are not aware of antibiotic resistance. Even the rich and educated take antibiotics if they fall ill or pressure doctors to prescribe antibiotics.Ç×»ýÁ¦¿¡ ´ëÇÑ Áö½ÄÀÌ ³Î¸® ºÎÁ·ÇÏ´Ù´Â °ÍÀº ´ëºÎºÐÀÇ È¯ÀÚµé - ½Ã°ñ°ú µµ½Ã -ÀÌ Ç×»ýÁ¦ ³»¼ºÀ» ÀνÄÇÏÁö ¸øÇÑ´Ù´Â °ÍÀ» ÀǹÌÇÑ´Ù. ºÎÀ¯ÇÏ°í ±³À°¹ÞÀº »ç¶÷µé Á¶Â÷ º´¿¡ °É¸®°Å³ª ÀÇ»çµé¿¡°Ô Ç×»ýÁ¦¸¦ ó¹æÇϵµ·Ï ¾Ð·ÂÀ» °¡Çϸé Ç×»ýÁ¦¸¦ º¹¿ëÇÑ´Ù.As prices of antibiotics fall and diagnostics remain expensive, doctors prefer to prescribe drugs rather than order tests. "Doctors are sometimes not sure what they are treating, and they want to treat everything by using broad-spectrum drugs," says Dr Walia.Ç×»ýÁ¦ °¡°ÝÀÌ ¶³¾îÁö°í Áø´Ü ºñ¿ëÀÌ ºñ½ÎÁö¸é¼ ÀÇ»çµéÀº °Ë»ç¸¦ ÁÖ¹®Çϱ⠺¸´Ù´Â ¾àÀ» ó¹æÇÏ´Â °ÍÀ» ¼±È£ÇÑ´Ù. "ÀÇ»çµéÀº ¶§¶§·Î ±×µéÀÌ ¹«¾ùÀ» Ä¡·áÇÏ°í ÀÖ´ÂÁö È®½ÅÇÏÁö ¸øÇϸç, ±×µéÀº ±¤¹üÀ§ÇÑ ¾à¹°À» »ç¿ëÇÔÀ¸·Î½á ¸ðµç °ÍÀ» Ä¡·áÇϱ⸦ ¿øÇÕ´Ï´Ù,"¶ó°í ¿Ð¸®¾Æ ¹Ú»ç´Â ¸»ÇÑ´Ù.Hospital infections are also to blame. Patients are often pumped with antibiotics to compensate for poor hygiene and sanitation, "because no doctor wants to lose a patient because of an infection".º´¿ø °¨¿°µµ Ã¥ÀÓÀÌ ÀÖ´Ù. ȯÀÚµéÀº Á¾Á¾ "°¨¿°À¸·Î ÀÎÇØ È¯ÀÚ¸¦ ÀÒ°í ½Í¾îÇÏ´Â Àǻ簡 ¾ø±â ¶§¹®¿¡" ¿¾ÇÇÑ À§»ý ¹× À§»ýÀ» º¸¿ÏÇϱâ À§ÇØ Ç×»ýÁ¦¸¦ Åõ¿©ÇÕ´Ï´Ù."It is a perfect storm as far as India goes. There are lots of infectious diseases in the background, lack of infection control and a lot of unnecessary consumption of antibiotics," Ramanan Laxminarayan, director of the One Health Trust, a global public health think tank, says."Àεµ¿¡ °üÇÑ ÇÑ ¿Ïº®ÇÑ ÆødzÀÌ´Ù.¼¼°èÀûÀÎ °øÁߺ¸°Ç ½ÌÅ©ÅÊÅ©ÀÎ ¿øÇコ Æ®·¯½ºÆ®ÀÇ ¶ó¸¶³ ¶ô½º¹Ì³ª¶ó¾á ¼ÒÀåÀº "¹è°æ¿¡´Â ¸¹Àº Àü¿°º´ÀÌ ÀÖ°í, °¨¿°°ü¸®°¡ ºÎÁ·Çϸç, ºÒÇÊ¿äÇÑ Ç×»ýÁ¦ ¼Òºñ°¡ ¸¹´Ù"°í ¸»ÇÑ´Ù.Experts believe India needs to invest more in and beef up diagnostic labs, produce more infectious diseases physicians, reduce hospital infections and train doctors on usage of antibiotics based on tests to tackle the rising threat of superbugs. Otherwise, "resistance to antibiotics has the potential of taking the form of a pandemic in near future," warns Dr Walia.Àü¹®°¡µéÀº Àεµ°¡ ½´ÆÛ¹ö±×ÀÇ Áõ°¡ÇÏ´Â À§Çù¿¡ ´ëóÇϱâ À§ÇÑ Å×½ºÆ®¸¦ ¹ÙÅÁÀ¸·Î Áø´Ü ¿¬±¸¼Ò¿¡ ´õ ¸¹Àº ÅõÀÚ¸¦ ÇÏ°í °ÈÇÏ°í, ´õ ¸¹Àº Àü¿°º´ Àǻ縦 ¹èÃâÇÏ°í, º´¿ø °¨¿°À» ÁÙÀÌ°í, ÀÇ»çµé¿¡°Ô Ç×»ýÁ¦ »ç¿ë¿¡ ´ëÇØ ÈƷýÃų ÇÊ¿ä°¡ ÀÖ´Ù. ±×·¸Áö ¾ÊÀ¸¸é, "Ç×»ýÁ¦¿¡ ´ëÇÑ ÀúÇ×Àº °¡±î¿î ¹Ì·¡¿¡ À¯ÇິÀÇ ÇüŸ¦ ÃëÇÒ °¡´É¼ºÀÌ ÀÖ´Ù"°í ¿ù¸®¾Æ ¹Ú»ç´Â °æ°íÇÑ´Ù.[bbc] https://www.bbc.com/news/world-asia-india-63059585
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