抗生素的抗藥菌- (1)

Antibiotic-resistant microbes highlight our overuse of the world’s shared resources-

抗生素的抗藥菌- (1)- 突顯出我們過度使用全球共享的資源

By Thomas Levenson GLOBE CORRESPONDENT  MARCH 05, 2017

《編按》：

抗生素俗稱美國仙丹，對一般感染(infection) 若適當投給(但濾過性病毒無效)，應屬有效。當有時因使用泛濫，即使用對的藥，也會變得無效。原因可能是患者已產生某種抗藥性(resistance) 。常見某些醫生為迅速治癒病症，常不擇手段，逐步加重劑量(osage) ，或使用更新一代的抗生素(antibiotics) ，導致患者體內之抗體(antibody) 產生不了作用，除副作用多元化出現外(如耳聾等) ，最後抗生素無效….. 而致不幸死亡……。

   

                     肺炎菌類                                                              濾過性病毒

IT BEGAN with a broken leg. On a long journey through India, a Nevada

resident in her 70s fractured her femur. Complications took her to several Indian hospitals. Eventually, she returned to the United States, but her

problems followed her home. In August of last year, she had to be hospitalized once again. In Reno, she presented with systemic

inflammatory response syndrome — a condition that can produce a racing heart, frantic breathing, and other symptoms. The syndrome often marks a powerful immune response to an infection. So her doctors looked for a microbe that might have provoked her increasingly devastating response.

病例的發生是從一條斷腿開始。在穿越印度的長途旅行中, 一位70多歲的內華達州居民，遭受到股骨骨折。因併發症，她住入了幾家印度的醫院。最後, 她回到美國, 但她的病症跟著她回到美國。去年 8月, 她不得不再次入院治療。在賭城雷諾市, 她的身體出現全身發炎症-此症候群可以產生心臟急跳, 瘋狂的呼吸, 和其他症狀。這種症候群通常是強大免疫體對某一感染的反應。因此, 她的醫生們尋找一種，可能激起她具日益毀滅性反應的病菌微生物。

They found it: Klebsiella pneumoniae, a bacterium that occurs naturally in soils and can live quite peaceably in human guts, mouth, or skin. If it makes its way elsewhere, it can cause disease — often pneumonia, but a number of other conditions as well. Until recently, the treatment for a K. pneumoniae infection was simple and effective: Give the patient one of a range of common antibiotics. Accordingly, her medical team tested the patient’s bacterial samples to see which drug would work.

他們找到: 它叫克雷伯肺炎菌, 一種在土壤中自然發生的細菌, 可以在人類的內臟、口腔或皮膚中，相當和平地生存著。如果它朝向身體別處,它可能導致的疾病-經常是肺炎, 但也有許多其他情況。直到最近, 對肺炎鏈球菌，簡單而有效的治療是: 給病人一種常見的抗生素。因此, 她的醫療團隊檢查了病人的細菌樣本, 以便看看哪種藥物有效。

The answer came back: none of them. Her microbes were resistant to all 14 antibiotics available in Reno. The hospital sent samples to the federal Centers for Disease Control and Prevention, and the tests there showed that these bugs were resistant to 12 more drugs. That was it. There was nothing else available in the United States that could touch this disease. (For more details on this unsettling case, see Helen Branswell’s coverage in The Boston Globe’s sister publication, STAT.)

答案找到了: 沒有一種有效。她的微生物病菌對雷諾市，所有發現的14抗生素都有抗藥性。醫院將樣本送往聯邦疾病控制和預防中心, 那裡的測試顯示，這些細菌對12多種藥物有抗藥性。事情就是這樣。美國沒有其他的藥物能治癒這種疾病。(有關這個尚未解決病例的更多細節, 請參見海倫 Branswell在波士頓地球的姊妹出版物,的報導統計)。

In January, the CDC reported that the woman had died in early September, killed by a superbug for which there is no cure.

在 1月, 疾病控制中心報告說, 該名女子于9月初已病故, 她死於迄今尚無法治癒的超級病菌。

Each death, of course, is a private grief for a family and community. This one has broad public meaning as well. It’s possible to say it was just bad luck: A traveler falls and then happens to come into contact with a microbe too tough for modern medicine to handle. But it’s just as true to say that billions of human choices made over the last 70 years killed this woman.

當然，每件病例死亡, 是一個家庭和社區的私人悲痛。但此件也有廣泛的公眾意義。有可能說這只是件倒楣的事: 一個旅行者摔倒了, 然後碰巧接觸到了，現代醫學難以處理的微生物病菌。但同樣正確的說法是, 在過去70多年來, 數十億人類的發現選擇，竟致使這個女士死亡。

TOLD THAT WAY, the story of this death is a tragedy, in the classical sense of the term: not simply an individual loss, but the last act in a series of events that remorselessly progressed to a terrifying conclusion. After their introduction in the 1940s, antibiotic drugs seemingly crushed the scourge of microbial disease that had until then been humanity’s most formidable killer. This catalog of drugs, available across national borders, became a shared resource for all. But over time, the overuse of antibiotics allowed drug-resistant microbes to emerge, thereby putting that resource at risk.

這樣說好了, 用古典術語的意義來說，這個死亡病例是一個悲劇: 在無情進展到一個可怕的結果的一系列事件中，它不僅是個人的損失, 也是最終的行為。在二十世紀四十年代，抗生素藥物被引介之後, 它乎粉碎了微生物病菌的禍害, 直到那時，它是人類最可怕的殺手。這種藥品目錄遍佈跨越國界, 成為人人共用的資源。但隨著時間的推移, 抗生素的過度使用，抗藥微生物菌類出現, 從而使這種藥品資源處於危險之中。

There’s a name for this sort of loss: the “tragedy of the commons,” a phrase coined by the American biologist Garrett Hardin. The term “commons” has its roots in communally used land in feudal England; the Boston Common has a similar origin. Antibiotic resistance is just one of many examples of a modern common in crisis.

這類的醫療損失有一個名字叫: "公用地的悲劇",這是美國生物學家加勒特所杜撰的一句話。『公地』一詞源自英國封建的社區用地;波士頓共用地也有相似的起源。對抗生素的抗藥性，只是現代共同危機中，常見的許多例子之一。

Together, these crises have created new threats to human well-being and, as a death in Reno confirms, have resurrected some old ones, too. Collective action is required to address them. Tragically, current American politics is thoroughly ill-placed to provide it.

這些危機綜合地,給人類的福祉帶來了『新的威脅』, 如同在雷諾的一件死亡病例所證實，也使一些舊的危機復活了。我們需要採取集體行動來解決這些問題。可悲的是, 當前的美國政策是如此徹底地雜亂無章，以致無法提供有效的集體行動。

未完

Justin Lai編譯

12/06/2017