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style="font-family:"Calibri","sans-serif""><span style="color:black"><img alt="" id="_x0000_i1025" src="" style="width:465.6pt; height:51.3pt" /></span></span></span></span><span style="font-size:12pt"><span style="line-height:107%"><span style="font-family:"Times New Roman","serif""><span style="color:black"> </span></span></span></span></p> <p> </p> <p align="center" style="margin-top:0cm; margin-right:.15pt; margin-bottom:7.4pt; margin-left:4.4pt; text-align:center; margin:0cm 22.8pt 0.15pt 0.5pt"><span style="font-size:16px;"><span style="font-family:Arial,Helvetica,sans-serif;"><span style="line-height:110%"><span style="color:black"><b><span style="line-height:110%"><span style="color:#1f497d">Zadanie realizowane ze środków</span></span></b></span></span></span></span></p> <p align="center" style="margin-top:0cm; margin-right:0cm; margin-bottom:15.9pt; margin-left:4.4pt; text-align:center; margin:0cm 22.8pt 0.15pt 0.5pt"><span style="font-size:16px;"><span style="font-family:Arial,Helvetica,sans-serif;"><span style="line-height:110%"><span style="color:black"><b><span style="line-height:110%"><span style="color:#1f497d">Narodowego Programu Zdrowia na lata 2021-2025,</span></span></b></span></span></span></span></p> <p align="center" style="margin-top:0cm; margin-right:0cm; margin-bottom:15.9pt; margin-left:4.4pt; text-align:center; margin:0cm 22.8pt 0.15pt 0.5pt"><span style="font-size:16px;"><span style="font-family:Arial,Helvetica,sans-serif;"><span style="line-height:110%"><span style="color:black"><b><span style="line-height:110%"><span style="color:#1f497d">finansowane przez Ministra Zdrowia</span></span></b></span></span></span></span></p> <p align="center" style="margin-top:0cm; margin-right:0cm; margin-bottom:12.3pt; margin-left:0cm; text-align:center; margin:0cm 22.8pt 0.15pt 0.5pt"> </p> <p align="center" style="margin-top:0cm; margin-right:22.1pt; margin-bottom:11.45pt; margin-left:0cm; text-align:center; margin:0cm 22.8pt 0.15pt 0.5pt"><span style="font-size:16px;"><span style="font-family:Arial,Helvetica,sans-serif;"><span style="line-height:103%"><span style="color:black"><b><span style="color:#1f497d">W dobie COVID-19 nie zapominaj o oporności na antybiotyki</span></b></span></span></span></span></p> <p align="center" style="margin-top:0cm; margin-right:22.1pt; margin-bottom:11.3pt; margin-left:0cm; text-align:center; margin:0cm 22.8pt 0.15pt 0.5pt"><span style="font-size:16px;"><span style="font-family:Arial,Helvetica,sans-serif;"><span style="line-height:103%"><span style="color:black"><b><span style="color:#1f497d">Epidemia antybiotykoopornych bakterii nadal trwa</span></b></span></span></span></span></p> <p align="center" style="margin-top:0cm; margin-right:22.1pt; margin-bottom:11.45pt; margin-left:0cm; text-align:center; margin:0cm 22.8pt 0.15pt 0.5pt"><span style="font-size:16px;"><span style="font-family:Arial,Helvetica,sans-serif;"><span style="line-height:103%"><span style="color:black"><b><span style="color:#1f497d">Działajmy wspólnie, aby utrzymać skuteczność antybiotyków</span></b></span></span></span></span></p> <p align="center" style="margin-top:0cm; margin-right:0cm; margin-bottom:5.75pt; margin-left:0cm; text-align:center; margin:0cm 22.8pt 0.15pt 0.5pt"> </p> <p align="center" style="margin-top:0cm; margin-right:23.05pt; margin-bottom:5.6pt; margin-left:0cm; text-align:center; margin:0cm 22.8pt 0.15pt 0.5pt"><span style="font-size:16px;"><span style="font-family:Arial,Helvetica,sans-serif;"><span style="line-height:107%"><span style="color:black"><b><span style="color:#1f497d">“ Wspólnie zapobiegajmy lekooporności”</span></b></span></span></span></span></p> <p align="center" style="margin-top:0cm; margin-right:22.9pt; margin-bottom:.0001pt; margin-left:0cm; text-align:center; margin:0cm 22.8pt 0.15pt 0.5pt"><span style="font-size:16px;"><span style="font-family:Arial,Helvetica,sans-serif;"><span style="line-height:107%"><span style="color:black"><b><span style="color:#1f497d">„Antybiotyki – stosuj rozważnie”</span></b></span></span></span></span></p> <p align="center" style="margin-top:0cm; margin-right:0cm; margin-bottom:9.95pt; margin-left:0cm; text-align:center; margin:0cm 22.8pt 0.15pt 0.5pt"> </p> <p align="center" style="margin-top:0cm; margin-right:22.1pt; margin-bottom:5.95pt; margin-left:0cm; text-align:center; margin:0cm 22.8pt 0.15pt 0.5pt"><span style="font-size:16px;"><span style="font-family:Arial,Helvetica,sans-serif;"><span style="line-height:107%"><span style="color:black"><b>„</b><b> Preventing Antimicrobial Resistance Together” (WHO)</b></span></span></span></span></p> <p align="center" style="margin-top:0cm; margin-right:22.1pt; margin-bottom:5.95pt; margin-left:0cm; text-align:center; margin:0cm 22.8pt 0.15pt 0.5pt"><span style="font-size:16px;"><span style="font-family:Arial,Helvetica,sans-serif;"><span style="line-height:107%"><span style="color:black"><b>„Antimicrobials: Handle with Care” (WHO)</b></span></span></span></span></p> <p align="center" style="margin-top:0cm; margin-right:246.7pt; margin-bottom:.1pt; margin-left:0cm; text-align:center; margin:0cm 22.8pt 0.15pt 0.5pt"> </p> <p align="center" style="margin-top:0cm; margin-right:23.0pt; margin-bottom:5.6pt; margin-left:0cm; text-align:center; margin:0cm 22.8pt 0.15pt 0.5pt"><span style="font-size:16px;"><span style="font-family:Arial,Helvetica,sans-serif;"><span style="line-height:107%"><span style="color:black"><b><span style="color:#1f497d">– pakiet prasowy z okazji</span></b></span></span></span></span></p> <p align="center" style="margin-top:0cm; margin-right:22.1pt; margin-bottom:6.25pt; margin-left:0cm; text-align:center; margin:0cm 22.8pt 0.15pt 0.5pt"><span style="font-size:16px;"><span style="font-family:Arial,Helvetica,sans-serif;"><span style="line-height:103%"><span style="color:black"><b><span style="color:#1f497d">Europejskiego Dnia Wiedzy o Antybiotykach (EAAD)</span></b></span></span></span></span></p> <p align="center" style="margin-top:0cm; margin-right:22.1pt; margin-bottom:7.4pt; margin-left:0cm; text-align:center; margin:0cm 22.8pt 0.15pt 0.5pt"><span style="font-size:16px;"><span style="font-family:Arial,Helvetica,sans-serif;"><span style="line-height:103%"><span style="color:black"><b><span style="color:#1f497d">i Światowego Tygodnia Wiedzy o Antybiotykach (WAAW)</span></b></span></span></span></span></p> <p style="margin-top:0cm; margin-right:0cm; margin-bottom:5.95pt; margin-left:0cm; margin:0cm 22.8pt 0.15pt 0.5pt; text-align:justify"><span style="font-size:16px;"><span style="font-family:Arial,Helvetica,sans-serif;"><span style="line-height:107%"><span style="color:black">             </span></span></span></span></p> <p style="margin-top:0cm; margin-right:22.25pt; margin-bottom:.15pt; margin-left:-.25pt; margin:0cm 22.8pt 0.15pt 0.5pt; text-align:justify"><span style="font-size:16px;"><span style="font-family:Arial,Helvetica,sans-serif;"><span style="line-height:149%"><span style="color:black"> Przed odkryciem antybiotyków tysiące ludzi umierało z powodu zakażeń bakteryjnych, takich jak zapalenie płuc lub infekcje po zabiegach chirurgicznych.  Od samego początku ery antybiotykowej obserwowano pojawianie się bakterii opornych, ale przez wiele lat było to zjawisko sporadyczne. Z upływem czasu coraz więcej bakterii, które początkowo były podatne na tę grupę leków, stawało się opornymi dzięki wypracowaniu wielu różnych sposobów walki z antybiotykami. Wykazano, że nadużywanie i niewłaściwe stosowanie tej grupy leków przyśpiesza ten proces.  Ponieważ oporność stale wzrasta, a w ostatnich latach odkryto i wprowadzono do obrotu niewiele nowych antybiotyków, oporność na antybiotyki jest obecnie poważnym zagrożeniem dla zdrowia publicznego.  Naukowcy oszacowali, że oporność na środki przeciwdrobnoustrojowe u bakterii spowodowała około 1,27 miliona zgonów w 2019 r. [1] </span></span></span></span></p> <p style="margin-top:0cm; margin-right:22.1pt; margin-bottom:11.75pt; margin-left:-.25pt; margin:0cm 22.8pt 0.15pt 0.5pt; text-align:justify"><span style="font-size:16px;"><span style="font-family:Arial,Helvetica,sans-serif;"><span style="line-height:149%"><span style="color:black">Bez antybiotyków możemy wrócić do „ery przedantybiotykowej”, kiedy nawet nieskomplikowane zakażenie mogło skończyć się zgonem pacjenta. Organizacje odpowiedzialne za zdrowie publiczne ostrzegają, że zaledwie 75 lat po szerokim wprowadzeniu penicyliny, pierwszego antybiotyku, stoimy przed faktem braku skutecznych leków do leczenia niektórych infekcji bakteryjnych. </span></span></span></span></p> <p style="margin-top:0cm; margin-right:22.1pt; margin-bottom:.4pt; margin-left:-.75pt; margin:0cm 22.8pt 0.15pt 0.5pt; text-align:justify"><span style="font-size:16px;"><span style="font-family:Arial,Helvetica,sans-serif;"><span style="line-height:149%"><span style="color:black"> <span style="color:#0d0d0d">Globalny plan działania (GAP) [2] na rzecz rozwiązania rosnącego problemu oporności na antybiotyki i inne leki przeciwdrobnoustrojowe został zatwierdzony  w maju 2015r. podczas Światowego Zgromadzenia Zdrowia. Państwa na całym świecie zobowiązały się do opracowania i wdrożenia wielosektorowych krajowych planów przeciwdziałania lekooporności. Jednym z kluczowych celów planu jest poprawa świadomości<br /> i zrozumienia oporności na środki przeciwdrobnoustrojowe poprzez skuteczną komunikację, edukację i szkolenia. Dlatego też</span> Światowa Organizacja Zdrowia (WHO)<br /> i Europejskie Centrum Kontroli i Profilaktyki Chorób (ECDC) zachęcają do prowadzenia działań zwiększających świadomość ogółu społeczeństwa, pracowników ochrony zdrowia jak też decydentów na temat tego, czym jest oporność na antybiotyki, dzielenia się informacjami o jej konsekwencjach i pokazywania, w jaki sposób działania poszczególnych osób, rodzin, specjalistów i społeczności wpływają na rozprzestrzenianie się oporności na środki przeciwdrobnoustrojowe.  </span></span></span></span></p> <p style="margin-top:0cm; margin-right:22.1pt; margin-bottom:1.1pt; margin-left:-.25pt; margin:0cm 22.8pt 0.15pt 0.5pt; text-align:justify"><span style="font-size:16px;"><span style="font-family:Arial,Helvetica,sans-serif;"><span style="line-height:149%"><span style="color:black">Poprzez zaangażowanie się w globalne działania kampanii i szerzenie wiedzy na temat oporności możemy mieć wpływ na zmniejszenie tego zjawiska. </span></span></span></span></p> <p style="margin-top:0cm; margin-right:0cm; margin-bottom:6.1pt; margin-left:0cm; margin:0cm 22.8pt 0.15pt 0.5pt; text-align:justify"><span style="font-size:16px;"><span style="font-family:Arial,Helvetica,sans-serif;"><span style="line-height:107%"><span style="color:black">             </span></span></span></span></p> <p style="margin-top:0cm; margin-right:22.25pt; margin-bottom:.15pt; margin-left:-.25pt; margin:0cm 22.8pt 0.15pt 0.5pt; text-align:justify"><span style="font-size:16px;"><span style="font-family:Arial,Helvetica,sans-serif;"><span style="line-height:149%"><span style="color:black"> W dniu 18 listopada w krajach Unii Europejskich obchodzimy <span style="color:#1f497d">Europejski Dzień Wiedzy Antybiotykach </span>(EAAD, ang. European Antibiotic Awareness Day), który został ustanowiony w 2008 roku przez Europejskie Centrum Zapobiegania i Kontroli Chorób (ECDC ang. European Centre for Disease Prevention and Control) [3]. </span></span></span></span></p> <p style="margin-top:0cm; margin-right:22.25pt; margin-bottom:.15pt; margin-left:-.25pt; margin:0cm 22.8pt 0.15pt 0.5pt; text-align:justify"><span style="font-size:16px;"><span style="font-family:Arial,Helvetica,sans-serif;"><span style="line-height:149%"><span style="color:black">  W dniach 18-24 listopada 2022 roku obchodzimy również <span style="color:#1f497d">Światowy Tydzień Wiedzy<br /> o Antybiotykach </span>(WAAW, ang. World Antibiotic Awareness Week), który został ustanowiony przez Światową Organizację Zdrowia w 2015 r. [4] </span></span></span></span></p> <p style="margin-top:0cm; margin-right:.1pt; margin-bottom:.15pt; margin-left:-.25pt; margin:0cm 22.8pt 0.15pt 0.5pt; text-align:justify"><span style="font-size:16px;"><span style="font-family:Arial,Helvetica,sans-serif;"><span style="line-height:149%"><span style="color:black"> </span></span></span></span></p> <p style="margin-top:0cm; margin-right:.1pt; margin-bottom:.15pt; margin-left:-.25pt; margin:0cm 22.8pt 0.15pt 0.5pt; text-align:justify"> </p> <p style="margin-top:0cm; margin-right:.1pt; margin-bottom:.15pt; margin-left:-.25pt; margin:0cm 22.8pt 0.15pt 0.5pt; text-align:justify"><span style="font-size:16px;"><span style="font-family:Arial,Helvetica,sans-serif;"><span style="line-height:149%"><span style="color:black">Narodowy Instytut Leków koordynuje w Polsce działania kampanii <span style="color:#1f497d">Europejski Dzień Wiedzy o Antybiotykach i Światowy Tydzień Wiedzy o Antybiotykach’20</span><span style="color:#244061">22 </span> w ramach realizacji Narodowego Programu Zdrowia na lata 2021-2025 finansowanego  ze środków Ministra Zdrowia.  </span></span></span></span></p> <p style="margin-top:0cm; margin-right:0cm; margin-bottom:11.5pt; margin-left:-.25pt; margin:0cm 22.8pt 0.15pt 0.5pt; text-align:justify"><span style="font-size:16px;"><span style="font-family:Arial,Helvetica,sans-serif;"><span style="line-height:151%"><span style="color:black">            Kampanie Europejski Dzień Wiedzy o Antybiotykach oraz Światowy Tydzień Wiedzy<br /> o Antybiotykach mają na celu zwrócenie uwagi decydentów, pracowników ochrony zdrowia<br /> i opinii publicznej na problem globalnej oporności na środki przeciwdrobnoustrojowe<br /> i zachęcenie wszystkich do przeciwdziałaniu temu zjawisku.</span></span></span></span></p> <p style="margin-top:0cm; margin-right:0cm; margin-bottom:.0001pt; margin-left:-.85pt; margin:0cm 22.8pt 0.15pt 0.5pt; text-align:justify"><span style="font-size:16px;"><span style="font-family:Arial,Helvetica,sans-serif;"><span style="line-height:150%"><span style="color:black"><span style="color:#1f497d"> Każdy z nas może być orędownikiem szerzenia wiedzy i zwiększania świadomości<br /> w zakresie problemu oporności na środki przeciwdrobnoustrojowe, w tym oporności bakterii na antybiotyki (AMR)!  </span></span></span></span></span></p> <p style="margin-top:0cm; margin-right:0cm; margin-bottom:6.2pt; margin-left:0cm; margin:0cm 22.8pt 0.15pt 0.5pt; text-align:justify"><span style="font-size:16px;"><span style="font-family:Arial,Helvetica,sans-serif;"><span style="line-height:107%"><span style="color:black"> </span></span></span></span></p> <p style="margin-top:0cm; margin-right:22.1pt; margin-bottom:.0001pt; margin-left:.5pt; margin:0cm 22.8pt 0.15pt 0.5pt; text-align:justify"> </p> <p style="margin-top:0cm; margin-right:22.1pt; margin-bottom:.0001pt; margin-left:.5pt; margin:0cm 22.8pt 0.15pt 0.5pt; text-align:justify"> </p> <p style="margin-top:0cm; margin-right:22.1pt; margin-bottom:.0001pt; margin-left:.5pt; margin:0cm 22.8pt 0.15pt 0.5pt; text-align:justify"><span style="font-family:Arial,Helvetica,sans-serif;"><span style="font-size:16px;"><span style="line-height:158%"><span style="color:black"><v:group coordsize="381,1798" id="Group_x0020_7324" style="position:absolute; left:0; text-align:left; margin-left:0; margin-top:-3.4pt; width:3pt; height:14.15pt; z-index:-1"> <img alt="" coordsize="38100,179832" fillcolor="#d2e3fc" id="Shape_x0020_9261" path="m,l38100,r,179832l,179832,,e" src="" stroked="f" strokeweight="0" style="position:absolute; width:381; height:1798" /> <v:stroke joinstyle="miter" miterlimit="10" opacity="0"> </v:stroke></v:group></span></span><span style="line-height:158%"><span style="color:black"><span style="position:relative"><span style="z-index:-1"><span style="left:0px; width:4px"><span style="position:absolute"><span style="top:-5px"><span style="height:19px"><img alt="" src="file:///C:\Users\wydor_k\AppData\Local\Temp\msohtmlclip1\01\clip_image007.gif" style="width:4px; height:19px" /></span></span></span></span></span></span> <span style="color:#1f497d">WHO wskazuje następujące cele kampanii Światowy Tydzień Wiedzy o Antybiotykach: </span>         <span style="color:#1f497d">Sprawić, by AMR stała się globalnie rozpoznawalnym zagrożeniem.</span></span></span></span></span></p> <ul> <li style="margin-top:0cm; margin-right:0cm; margin-bottom:.6pt; margin:0cm 22.8pt 0.15pt 36pt; text-align:justify"><span style="font-family:Arial,Helvetica,sans-serif;"><span style="font-size:16px;"><span style="line-height:151%"><span style="color:black">W tym celu zgodnie z podejściem „One Health - Jedno zdrowie” należy zaangażować wszystkie sektory gdzie stosuje się antybiotyki tj. medycynę, weterynarię, rolnictwo<br /> i środowisko </span></span></span></span></li> <li style="margin-top:0cm; margin-right:22.25pt; margin-bottom:.15pt; margin:0cm 22.8pt 0.15pt 0.5pt; text-align:justify"><span style="font-family:Arial,Helvetica,sans-serif;"><span style="font-size:16px;"><span style="line-height:149%"><span style="color:black"><span style="color:#1f497d">Zwiększyć świadomość </span>o konieczności podjęcia natychmiastowych działań w celu ochrony skuteczności środków przeciwdrobnoustrojowych przez odpowiedzialne<br /> i rozważne ich stosowanie<span style="color:#0d0d0d"> wśród</span> ogółu społeczeństwa, pracowników ochrony zdrowia jak też decydentów, poprzez skuteczną komunikacje, edukację i szkolenia.  </span></span></span></span></li> <li style="margin-top:0cm; margin-right:22.25pt; margin-bottom:.15pt; margin:0cm 22.8pt 0.15pt 0.5pt; text-align:justify"><span style="font-family:Arial,Helvetica,sans-serif;"><span style="font-size:16px;"><span style="line-height:149%"><span style="color:black"><span style="color:#1f497d">Zachęcić do zmiany zachowania </span>i bardziej rozważnego stosowania środków przeciwdrobnoustrojowych we wszystkich sektorach i przekazać wiadomość,<br /> że proste działania mogą przynieść duże korzyści. </span></span></span></span></li> </ul> <p style="margin:0cm; margin-bottom:.0001pt; text-align:justify"><span style="font-family:Arial,Helvetica,sans-serif;"><span style="font-size:16px;"><span style="line-height:107%"><span style="color:black"> </span></span></span></span></p> <p style="margin-top:0cm; margin-right:22.1pt; margin-bottom:.0001pt; margin-left:-.25pt; margin:0cm 22.8pt 0.15pt 0.5pt; text-align:justify"><span style="font-family:Arial,Helvetica,sans-serif;"><span style="font-size:16px;"><span style="line-height:149%"><span style="color:black"><span style="color:#1f497d">Europejskie Centrum Kontroli i Profilaktyki Chorób wskazuje, co każdy z nas może zrobić aby przyczynić się do utrzymania skuteczności antybiotyków: </span></span></span></span></span></p> <ul> <li style="margin-right:22.25pt; margin:0cm 22.8pt 0.0001pt 36pt; text-align:justify"><span style="font-family:Arial,Helvetica,sans-serif;"><span style="font-size:16px;"><span style="line-height:149%"><span style="color:black">Stosuj antybiotyki tylko przeciwko infekcjom bakteryjnym, a nie przeciw infekcjom wywoływanym przez wirusy takim jak przeziębienie czy grypa. </span></span></span></span></li> <li style="margin-top:0cm; margin-right:22.25pt; margin-bottom:5.8pt; margin:0cm 22.8pt 0.0001pt 36pt; text-align:justify"><span style="font-family:Arial,Helvetica,sans-serif;"><span style="font-size:16px;"><span style="line-height:107%"><span style="color:black">Przyjmuj wyłącznie antybiotyki przepisane przez lekarza. </span></span></span></span></li> <li style="margin-right:22.25pt; margin:0cm 22.8pt 0.0001pt 36pt; text-align:justify"><span style="font-family:Arial,Helvetica,sans-serif;"><span style="font-size:16px;"><span style="line-height:149%"><span style="color:black">Gdy lekarz stwierdzi, że antybiotyki są konieczne, przyjmuj je w sposób odpowiedzialny, zgodnie z zaleceniami lekarza w zakresie dawkowania i czasu trwania terapii. </span></span></span></span></li> <li style="margin-right:22.25pt; margin:0cm 22.8pt 0.0001pt 36pt; text-align:justify"><span style="font-family:Arial,Helvetica,sans-serif;"><span style="font-size:16px;"><span style="line-height:149%"><span style="color:black">Unikaj samoleczenia antybiotykami. Samoleczenie ma miejsce wtedy, gdy używasz  antybiotyków pozostałych z poprzednich terapii lub otrzymujesz antybiotyki w aptece bez recepty. </span></span></span></span></li> <li style="margin-right:22.25pt; margin:0cm 22.8pt 0.0001pt 36pt; text-align:justify"><span style="font-family:Arial,Helvetica,sans-serif;"><span style="font-size:16px;"><span style="line-height:107%"><span style="color:black">Nie dziel się antybiotykami pozostałymi z poprzedniej terapii z innymi ludźmi. </span></span></span></span></li> <li style="margin-right:22.25pt; margin:0cm 22.8pt 0.15pt 36pt; text-align:justify"><span style="font-family:Arial,Helvetica,sans-serif;"><span style="font-size:16px;"><span style="line-height:149%"><span style="color:black">Nie przechowuj antybiotyków pozostałych z poprzednich terapii. Jeśli otrzymałeś więcej dawek antybiotyków (np. tabletki, kapsułki żelowe) niż zalecił lekarz, zanieś te niezużyte do apteki w celu ich utylizacji. </span></span></span></span></li> </ul> <p style="margin-top:0cm; margin-right:22.1pt; margin-bottom:1.45pt; margin-left:-.25pt; margin:0cm 22.8pt 0.15pt 0.5pt; text-align:justify"><span style="font-family:Arial,Helvetica,sans-serif;"><span style="font-size:16px;"><span style="line-height:103%"><span style="color:black"><span style="color:#1f497d">OPORNOŚĆ NA ŚRODKI PRZECIWDROBNOUSTROJOWE - KLUCZOWE FAKTY </span></span></span></span></span></p> <p style="margin-top:0cm; margin-right:22.1pt; margin-bottom:12.0pt; margin-left:-.25pt; margin:0cm 22.8pt 0.15pt 0.5pt; text-align:justify"><span style="font-family:Arial,Helvetica,sans-serif;"><span style="font-size:16px;"><span style="line-height:103%"><span style="color:black"><span style="color:#1f497d">WSKAZANE PRZEZ WHO [4] </span></span></span></span></span></p> <ul> <li style="margin-top:0cm; margin-right:22.25pt; margin-bottom:.15pt; margin:0cm 22.8pt 0.15pt 0.5pt; text-align:justify"><span style="font-family:Arial,Helvetica,sans-serif;"><span style="font-size:16px;"><span style="line-height:149%"><span style="color:black">Oporność na środki przeciwdrobnoustrojowe jest globalnym zagrożeniem dla zdrowia<br /> i rozwoju. Wymaga pilnych wielosektorowych działań w celu osiągnięcia Celów Zrównoważonego Rozwoju (SDG, ang. Sustainable Development Goals). </span></span></span></span></li> <li style="margin-top:0cm; margin-right:22.25pt; margin-bottom:.15pt; margin:0cm 22.8pt 0.15pt 0.5pt; text-align:justify"><span style="font-family:Arial,Helvetica,sans-serif;"><span style="font-size:16px;"><span style="line-height:149%"><span style="color:black">WHO ogłosiła, że oporność na środki przeciwdrobnoustrojowe jest jednym z 10 największych globalnych zagrożeń zdrowia publicznego, przed którymi stoi ludzkość. </span></span></span></span></li> <li style="margin-top:0cm; margin-right:22.25pt; margin-bottom:.15pt; margin:0cm 22.8pt 0.15pt 0.5pt; text-align:justify"><span style="font-family:Arial,Helvetica,sans-serif;"><span style="font-size:16px;"><span style="line-height:149%"><span style="color:black">Nadmierne i/lub niewłaściwe stosowanie środków przeciwdrobnoustrojowych to główne czynniki sprzyjające rozwojowi i rozprzestrzenianiu opornych na antybiotyki patogenów bakteryjnych. </span></span></span></span></li> <li style="margin-top:0cm; margin-right:22.25pt; margin-bottom:.15pt; margin:0cm 22.8pt 0.15pt 0.5pt; text-align:justify"><span style="font-family:Arial,Helvetica,sans-serif;"><span style="font-size:16px;"><span style="line-height:149%"><span style="color:black">Brak dostępu do czystej wody, urządzeń sanitarnych oraz nieodpowiednie zapobieganie i zwalczanie zakażeń sprzyja rozprzestrzenianiu się drobnoustrojów, także <span style="color:#0d0d0d">tych, które są oporne na leki przeciwdrobnoustrojowe. </span></span></span></span></span></li> <li style="margin-top:0cm; margin-right:22.25pt; margin-bottom:4.65pt; margin:0cm 22.8pt 0.15pt 0.5pt; text-align:justify"><span style="font-family:Arial,Helvetica,sans-serif;"><span style="font-size:16px;"><span style="line-height:149%"><span style="color:black"><span style="color:#0d0d0d">Koszt oporności na środki przeciwdrobnoustrojowe dla gospodarki jest znaczny. Oprócz niepełnosprawności, ciężka choroba spowodowana wielolekoopornymi szczepami (AMR) powoduje wydłużenie pobytu w szpitalu i zapotrzebowanie na droższe leki, co jest dużym obciążeniem finansowym dla budżetu państwa. </span></span></span></span></span></li> <li style="margin-top:0cm; margin-right:22.25pt; margin-bottom:.4pt; margin:0cm 22.8pt 0.15pt 0.5pt; text-align:justify"><span style="font-family:Arial,Helvetica,sans-serif;"><span style="font-size:16px;"><span style="line-height:149%"><span style="color:black"><span style="color:#0d0d0d">Bez skutecznych środków przeciwdrobnoustrojowych sukces współczesnej medycyny<br /> w walce z zakażeniami jest zagrożony. </span></span></span></span></span></li> </ul> <p style="margin:0cm; margin-bottom:.0001pt; text-align:justify"> </p> <p style="margin-top:0cm; margin-right:22.1pt; margin-bottom:6.4pt; margin-left:-.25pt; margin:0cm 22.8pt 0.15pt 0.5pt; text-align:justify"><span style="font-family:Arial,Helvetica,sans-serif;"><span style="font-size:16px;"><span style="line-height:103%"><span style="color:black"><span style="color:#1f497d">Co to jest oporność na środki przeciwdrobnoustrojowe (AMR)? </span></span></span></span></span></p> <p style="margin-top:0cm; margin-right:22.25pt; margin-bottom:.15pt; margin-left:-.25pt; margin:0cm 22.8pt 0.15pt 0.5pt; text-align:justify"><span style="font-family:Arial,Helvetica,sans-serif;"><span style="font-size:16px;"><span style="line-height:149%"><span style="color:black"> AMR występuje, g<span style="line-height:149%">d</span>y drobnoustroje, czyli bakterie, wirusy, grzyby i pasożyty przestają reagować na leki, co utrudnia lub uniemożliwia leczenie powszechnych zakażeń i zwiększa ryzyko ich rozprzestrzeniania się, jak też częściej prowadzi do ciężkiej choroby a nawet śmierci. </span></span></span></span></p> <ul> <li style="margin-top:0cm; margin-right:22.25pt; margin-bottom:.15pt; margin:0cm 22.8pt 0.15pt 0.5pt; text-align:justify"><span style="font-family:Arial,Helvetica,sans-serif;"><span style="font-size:16px;"><span style="line-height:149%"><span style="color:black">Wiele czynników przyspieszyło rozprzestrzenianie się oporności na środki przeciwdrobnoustrojowe na całym świecie – w tym nadużywanie i niewłaściwe stosowanie leków u ludzi, zwierząt hodowlanych i w rolnictwie, a także utrudniony dostęp do czystej wody, urządzeń sanitarnych i higieny. </span></span></span></span></li> <li style="margin-top:0cm; margin-right:22.25pt; margin-bottom:.15pt; margin:0cm 22.8pt 0.15pt 0.5pt; text-align:justify"><span style="font-family:Arial,Helvetica,sans-serif;"><span style="font-size:16px;"><span style="line-height:149%"><span style="color:black">W wyniku lekooporności antybiotyki i inne leki przeciwdrobnoustrojowe stają się nieskuteczne, a zakażenia są coraz trudniejsze lub niemożliwe do wyleczenia. </span></span></span></span></li> </ul> <p style="margin-top:0cm; margin-right:0cm; margin-bottom:1.45pt; margin-left:0cm; margin:0cm 22.8pt 0.15pt 0.5pt; text-align:justify"><span style="font-family:Arial,Helvetica,sans-serif;"><span style="font-size:16px;"><span style="line-height:107%"><span style="color:black"> </span></span></span></span></p> <p style="margin-top:0cm; margin-right:0cm; margin-bottom:1.45pt; margin-left:0cm; margin:0cm 22.8pt 0.15pt 0.5pt; text-align:justify"> </p> <p style="margin:0cm; margin-bottom:.0001pt; text-align:justify"><span style="font-family:Arial,Helvetica,sans-serif;"><span style="font-size:16px;"><span style="line-height:107%"><span style="color:black"> </span></span></span></span></p> <p style="margin-top:0cm; margin-right:22.1pt; margin-bottom:.0001pt; margin-left:-.25pt; margin:0cm 22.8pt 0.15pt 0.5pt; text-align:justify"><span style="font-family:Arial,Helvetica,sans-serif;"><span style="font-size:16px;"><span style="line-height:103%"><span style="color:black"><span style="color:#1f497d">WHO wyjaśnia, dlaczego oporność na środki przeciwdrobnoustrojowe jest problemem globalnym [4]: </span></span></span></span></span></p> <p style="margin:0cm; margin-bottom:.0001pt; text-align:justify"><span style="font-family:Arial,Helvetica,sans-serif;"><span style="font-size:16px;"><span style="line-height:107%"><span style="color:black"> </span></span></span></span></p> <ul> <li style="margin-top:0cm; margin-right:22.25pt; margin-bottom:.15pt; margin:0cm 22.8pt 0.15pt 0.5pt; text-align:justify"><span style="font-family:Arial,Helvetica,sans-serif;"><span style="font-size:16px;"><span style="line-height:149%"><span style="color:black">Pojawienie się i rozprzestrzenianie lekoopornych patogenów, z coraz nowymi mechanizmami oporności, prowadzące do oporności na wiele środków przeciwdrobnoustrojowych zagraża naszej zdolności leczenia infekcji.  Szczególnie niepokojące jest gwałtowne globalne rozprzestrzenianie się bakterii wielolekoopornych („superbakterie”), które powodują zakażenia, których nie można wyleczyć dostępnymi lekami przeciwdrobnoustrojowymi, takimi jak antybiotyki. </span></span></span></span></li> <li style="margin-top:0cm; margin-right:22.25pt; margin-bottom:.15pt; margin:0cm 22.8pt 0.15pt 0.5pt; text-align:justify"><span style="font-family:Arial,Helvetica,sans-serif;"><span style="font-size:16px;"><span style="line-height:149%"><span style="color:black">W 2019 r. WHO zidentyfikowała 32 antybiotyki będące w fazie badań klinicznych, które działają na gatunki bakterii wpisane na listę priorytetowych patogenów WHO, dla których niezbędne jest poszukiwanie nowych leków,  ale tylko sześć z nich zostało sklasyfikowanych, jako innowacyjne. Ze względu  na wielolekooporność drobnoustrojów brak skutecznych antybiotyków dotyka systemy opieki zdrowotnej w krajach na wszystkich poziomach rozwoju. </span></span></span></span></li> <li style="margin-top:0cm; margin-right:22.25pt; margin-bottom:.15pt; margin:0cm 22.8pt 0.15pt 0.5pt; text-align:justify"><span style="font-family:Arial,Helvetica,sans-serif;"><span style="font-size:16px;"><span style="line-height:149%"><span style="color:black">Antybiotyki są coraz mniej skuteczne w leczeniu zakażeń, ponieważ lekooporność drobnoustrojów rozprzestrzenia się na całym świecie. Pilnie potrzebne są nowe środki przeciwbakteryjne – na przykład do leczenia zakażeń wywoływanych przez bakterie Gram-ujemne oporne na karbapenemy, wskazane na liście priorytetowych patogenów WHO. Jeśli jednak ludzie nie zmienią natychmiast dotychczasowego sposobu stosowania leków przeciwbakteryjnych, to nowe antybiotyki spotka taki sam los jak obecnie dostępne i staną się one nieskuteczne. </span></span></span></span></li> <li style="margin-top:0cm; margin-right:22.25pt; margin-bottom:.15pt; margin:0cm 22.8pt 0.15pt 0.5pt; text-align:justify"><span style="font-family:Arial,Helvetica,sans-serif;"><span style="font-size:16px;"><span style="line-height:149%"><span style="color:black">Koszt oporności na środki przeciwdrobnoustrojowe dla gospodarek narodowych i ich systemów opieki zdrowotnej jest znaczny, nie tylko z powodu kosztów leczenia, ale również dlatego, że pacjenci lub ich opiekunowie poprzez przedłużone pobyty<br /> w szpitalu nie są w stanie świadczyć pracy. </span></span></span></span></li> <li style="margin-top:0cm; margin-right:22.25pt; margin-bottom:.15pt; margin:0cm 22.8pt 0.15pt 0.5pt; text-align:justify"><span style="font-family:Arial,Helvetica,sans-serif;"><span style="font-size:16px;"><span style="line-height:149%"><span style="color:black">Bez skutecznych narzędzi profilaktyki i odpowiedniego leczenia zakażeń wywoływanych przez lekooporne drobnoustroje oraz lepszego dostępu do istniejących i nowych środków przeciwdrobnoustrojowych o zapewnionej, jakości, wzrośnie liczba osób, których leczenie skończy się niepowodzeniem lub które umrą z powodu zakażeń. Procedury medyczne, takie jak operacje, w tym cięcie cesarskie lub wymiana stawu biodrowego, chemioterapia przeciwnowotworowa i przeszczepianie narządów, staną się bardziej ryzykowne. </span></span></span></span></li> </ul> <p style="margin-top:0cm; margin-right:0cm; margin-bottom:6.0pt; margin-left:21.35pt; margin:0cm 22.8pt 0.15pt 0.5pt; text-align:justify"><span style="font-family:Arial,Helvetica,sans-serif;"><span style="font-size:16px;"><span style="line-height:107%"><span style="color:black"> </span></span></span></span></p> <p style="margin-top:0cm; margin-right:22.1pt; margin-bottom:.0001pt; margin-left:-.25pt; margin:0cm 22.8pt 0.15pt 0.5pt; text-align:justify"> </p> <p style="margin-top:0cm; margin-right:22.1pt; margin-bottom:.0001pt; margin-left:-.25pt; margin:0cm 22.8pt 0.15pt 0.5pt; text-align:justify"><span style="font-family:Arial,Helvetica,sans-serif;"><span style="font-size:16px;"><span style="line-height:148%"><span style="color:black"><span style="color:#1f497d">WHO wskazuje, co przyspiesza powstawanie i rozprzestrzenianie się oporności na środki przeciwdrobnoustrojowe: </span></span></span></span></span></p> <p style="margin-top:0cm; margin-right:22.25pt; margin-bottom:2.2pt; margin-left:-.25pt; margin:0cm 22.8pt 0.15pt 0.5pt; text-align:justify"><span style="font-family:Arial,Helvetica,sans-serif;"><span style="font-size:16px;"><span style="line-height:149%"><span style="color:black">Drobnoustroje oporne na środki przeciwdrobnoustrojowe zasiedlają ludzi, zwierzęta, żywność, rośliny i środowisko (wodę, glebę i powietrze). Mogą przenosić się z osoby na osobę lub między ludźmi i zwierzętami, są w żywności pochodzenia zwierzęcego. Głównymi przyczynami powstawania i rozprzestrzeniania się oporności na środki przeciwdrobnoustrojowe są: </span></span></span></span></p> <ul> <li style="margin-top:0cm; margin-right:22.1pt; margin-bottom:.0001pt; margin:0cm 22.8pt 0.0001pt 36pt; text-align:justify"><span style="font-family:Arial,Helvetica,sans-serif;"><span style="font-size:16px;"><span style="line-height:150%"><span style="color:black">niewłaściwe stosowanie i nadużywanie środków przeciwdrobnoustrojowych;</span></span></span></span></li> <li style="margin-top:0cm; margin-right:22.1pt; margin-bottom:.0001pt; margin:0cm 22.8pt 0.0001pt 36pt; text-align:justify"><span style="font-family:Arial,Helvetica,sans-serif;"><span style="font-size:16px;"><span style="line-height:150%"><span style="color:black">brak dostępu do czystej wody i niska higiena; dotyczy to zarówno ludzi, jak<br /> i zwierząt;  </span></span></span></span></li> <li style="margin-top:0cm; margin-right:22.1pt; margin-bottom:.0001pt; margin:0cm 22.8pt 0.0001pt 36pt; text-align:justify"><span style="font-family:Arial,Helvetica,sans-serif;"><span style="font-size:16px;"><span style="line-height:150%"><span style="color:black">niewystarczająca profilaktyka i kontrola zakażeń w placówkach opieki zdrowotnej; </span></span></span></span></li> <li style="margin-top:0cm; margin-right:22.1pt; margin-bottom:.0001pt; margin:0cm 22.8pt 0.0001pt 36pt; text-align:justify"><span style="font-family:Arial,Helvetica,sans-serif;"><span style="font-size:16px;"><span style="line-height:150%"><span style="color:black">słaby dostęp do wysokiej jakości, niedrogich leków, szczepionek i diagnostyki;  </span></span></span></span></li> <li style="margin-top:0cm; margin-right:22.1pt; margin-bottom:.0001pt; margin:0cm 22.8pt 0.0001pt 36pt; text-align:justify"><span style="font-family:Arial,Helvetica,sans-serif;"><span style="font-size:16px;"><span style="line-height:150%"><span style="color:black">brak wiedzy i świadomości;  </span></span></span></span></li> <li style="margin-top:0cm; margin-right:22.1pt; margin-bottom:.0001pt; margin:0cm 22.8pt 0.15pt 36pt; text-align:justify"><span style="font-family:Arial,Helvetica,sans-serif;"><span style="font-size:16px;"><span style="line-height:150%"><span style="color:black">brak egzekwowania przepisów. </span></span></span></span></li> </ul> <p style="margin-top:0cm; margin-right:0cm; margin-bottom:5.6pt; margin-left:0cm; margin:0cm 22.8pt 0.15pt 0.5pt; text-align:justify"><span style="font-family:Arial,Helvetica,sans-serif;"><span style="font-size:16px;"><span style="line-height:107%"><span style="color:black"> </span></span></span></span></p> <p style="margin-top:0cm; margin-right:0cm; margin-bottom:5.5pt; margin-left:0cm; margin:0cm 22.8pt 0.15pt 0.5pt; text-align:justify"><span style="font-family:Arial,Helvetica,sans-serif;"><span style="font-size:16px;"><span style="line-height:107%"><span style="color:black"><span style="color:#44546a">Oporność na antybiotyki w Polsce i Europie w 2021 roku  - dane sieci EARS-Net </span></span></span></span></span></p> <p style="margin-top:0cm; margin-right:22.25pt; margin-bottom:10.0pt; margin-left:-.25pt; margin:0cm 22.8pt 0.15pt 0.5pt; text-align:justify"><span style="font-family:Arial,Helvetica,sans-serif;"><span style="font-size:16px;"><span style="line-height:149%"><span style="color:black">Monitorowanie zakażeń i oporności na antybiotyki dla krajów Unii Europejskiej (UE)<br /> i Europejskiego Obszaru Gospodarczego Islandii i Norwegii (EOG) jest prowadzone przez Europejskie Centrum Kontroli i Prewencji Chorób (ECDC) w Sztokholmie. Dane<br /> o wrażliwości na antybiotyki wybranych do monitorowania gatunków bakterii: Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Acinetobacter baumannii, Staphylococcus aureus, Enterococcus faecalis, Enterococcus faecium oraz Streptococcus pneumoniae izolowanych z krwi i płynu mózgowo-rdzeniowego zbierane  są w ramach Europejskiej Sieci Monitorowania Lekooporności EARS-Net (ang. European Antimicrobial Resistance Surveillance Network) i co roku w październiku publikowane przez ECDC w Surveillance Atlas of Infectious Diseases [5]. W Europie monitorowanie oporności na antybiotyki szczepów wyhodowanych z posiewów krwi i płynu mózgowo-rdzeniowego w krajach spoza UE i EOG jest prowadzone w ramach koordynowanej przez WHO sieci Central Asian and European Surveillance of Antimicrobial Resistance Network (CESAR). Zebrane przez obie sieci dane są w pierwszym kwartale kolejnego roku publikowane w zbiorczym raporcie, przygotowanym wspólnie przez ECDC<br /> i WHO. Monitorowanie oporności na antybiotyki w Polsce jest prowadzone w oparciu o dane nadsyłane przez laboratoria sieci EARS-Net, której koordynatorem jest Narodowy Instytut Leków w Warszawie. Dane z 2021 roku zostały nadesłane przez 52 laboratoria<br /> i obejmowały badania wykonane w 60 szpitalach z terenu całej Polski. </span></span></span></span></p> <p style="margin-top:0cm; margin-right:22.25pt; margin-bottom:9.85pt; margin-left:-.25pt; margin:0cm 22.8pt 0.15pt 0.5pt; text-align:justify"><span style="font-family:Arial,Helvetica,sans-serif;"><span style="font-size:16px;"><span style="line-height:149%"><span style="color:black">Pomimo trwającej pandemii SARS-Cov-2, w Europie w 2021r. w stosunku do roku 2020 zaobserwowano wzrost liczby zakażeń dla wszystkich patogenów raportowanych w sieci EARS-Net, przy czym największy zaobserwowano dla Acinetobacter spp. (+43%) i E. faecium (+21%) oraz niższe dla E. faecalis (+14%), S. aureus (+9,4%), czy  K. pneumoniae (+8,1%). W Polsce stwierdzono w 2021r. również wyższą liczbę izolatów z posiewów krwi niż w roku 2020 z wszystkich gatunków, przy czym najwięszy o 120% stwierdzono dla Acinetobacter spp., o 72% dla E. faecium, o 40% dla P. aeruginosa, o 58% dla E. faecalis, o 57% dla S. pneumoniae, o 32% dla K. pneumoniae, o 18% dla S. aureus oraz o 9% dla E. coli. </span></span></span></span></p> <p style="margin-top:0cm; margin-right:22.25pt; margin-bottom:10.0pt; margin-left:-.25pt; margin:0cm 22.8pt 0.15pt 0.5pt; text-align:justify"><span style="font-family:Arial,Helvetica,sans-serif;"><span style="font-size:16px;"><span style="line-height:149%"><span style="color:black">Największy niepokój w Polsce budzi ogromna o 120% wyższa w stosuknu do 2020r. liczba szczepów izolowanych z krwi z rodzaju Acinetobacter spp., głównie Acinetobacter bauamannii, gatunku, który może się utrzymywać w środowisku zakładów opieki zdrowotnej przez długi czas i jest niezwykle trudny do eradykacji. Zakażenia podobnie jak w latach poprzednich notowano głównie w oddziałach intesywnej terapii, ale odsetek ten (69% wszystkich izolatów) był wyższy niż w poprzednich latach, co ma niewątpliwie związek z występowaniem nadkażeń bakteryjnych u pacjentów leczonych w przebiegu zakażeń wirusem SARS-Cov-2. Jednocześnie u tego gatunku w ostatnich 5 latach stwierdzono statystycznie znamienny wzrost oporności na karbapenemy (w 2017r. 67,4%, w 2021r. 82,7%) i fluorochinolony (odpowiednio 83,0% i 92,6%) oraz występowania jednoczesnej oporności na karbapenemy, fluorochinolony i aminoglikozydy (odpowiednio 59,5% i 67,0%). Podobną sytuacje stwierdzono także w innych krajach w Europie, głównie tych, które przed 2020r. obserwowały wysokie odsetki oporności<br /> i liczby izolatów tego gatunku.  </span></span></span></span></p> <p style="margin-top:0cm; margin-right:22.25pt; margin-bottom:9.95pt; margin-left:-.25pt; margin:0cm 22.8pt 0.15pt 0.5pt; text-align:justify"><span style="font-family:Arial,Helvetica,sans-serif;"><span style="font-size:16px;"><span style="line-height:149%"><span style="color:black">Podobnie jak w latach poprzednich w 2021r. w Europie nadal obserwowano wzrost  odsetka oporności na karbapenemy u K. pneumoniae. Jest to także jeden z głównych problemów oporności na antybiotyki w Polsce, a wzrost odsetka oporności na karbapenemy jest związany z rozprzestrzenianiem się szczepów wytwarzających karbapenemazy typu NDM. KPC oraz OXA-48. W 2021r. w Polsce stwierdzono 32% wzrost liczby izolatów K. pneumoniae w stosunku do 2020r. oraz ponad dwukrotny z 8,2% w 2020r. do 19,5% w 2021r. wzrost odsetka szczepów opornych na karbapenemy. U tego gatunku stwierdzono znamienny statystycznie wzrost w ciągu ostatnich 5 lat oporności na karbapenemy (2017r. 6,4%, 2021r. 19,5%) oraz na cefalosporyny III genracji (odpowiednio 63,0% i 70,0%).  </span></span></span></span></p> <p style="margin-top:0cm; margin-right:22.25pt; margin-bottom:10.0pt; margin-left:-.25pt; margin:0cm 22.8pt 0.15pt 0.5pt; text-align:justify"><span style="font-family:Arial,Helvetica,sans-serif;"><span style="font-size:16px;"><span style="line-height:149%"><span style="color:black">W ostatnich 5 latach w Polsce u pałeczek jelitowych zaobserwowano również znamienne statystycznie spadki niektórych odsetków oporności, w tym na aminopenicyliny<br /> i fluorochinolony u E. coli z 69,4% w 2017r. do 60,6% w 2021r oraz odpowiednio z 35,9% do 33,1%, ale u tego gatunku w 2021r. obserwowano nadal wysoki 18,7% odsetek oporności na cefalosporyny III generacji, czyli jedną z podstawowych grup leków w leczeniu zakażeń wywoływanych prze ten gatunek bakterii.  </span></span></span></span></p> <p style="margin-top:0cm; margin-right:22.25pt; margin-bottom:10.0pt; margin-left:-.25pt; margin:0cm 22.8pt 0.15pt 0.5pt; text-align:justify"><span style="font-family:Arial,Helvetica,sans-serif;"><span style="font-size:16px;"><span style="line-height:149%"><span style="color:black">Wśród pałeczek Gram-ujemnych wyróżnia się P. aeruginosa, ponieważ dla tego gatunku<br /> w ostatnich 5 latach w Polsce zaobserwowaną znamienny statystycznie spadek oporności na ceftazydym, fluorochinolony i tobramycynę, odpowiednio w 2017r. 24,6%, 37,2%<br /> i 20,4%, a w 2021r. 20,4%, 32,3% oraz 12,1%. </span></span></span></span></p> <p style="margin-top:0cm; margin-right:22.25pt; margin-bottom:9.85pt; margin-left:-.25pt; margin:0cm 22.8pt 0.15pt 0.5pt; text-align:justify"><span style="font-family:Arial,Helvetica,sans-serif;"><span style="font-size:16px;"><span style="line-height:149%"><span style="color:black">Rok 2021 był w Polsce rokiem powrotu do liczby szczepów S. pneumoniae obserwowanych w latach wcześniejszych, chociaż nadal w stosunku do danych z 2019r.<br /> w 2021r. odnotowano spadek liczby szczepów S. pneumoniae o 25%. W 2021r. w stosunku do 2020r. zwiększył się natomiast odsetek szczepów niewrażliwych na penicylinę z 10,8% do 18,8% oraz szczepów niewrażliwych jednocześnie na penicylinę i makrolidy (azytromycynę, erytromycynę) z 9,5% do 14,8%, ale nie był to wzrost znamienny statystycznie w ciągu ostatnich 5 lat. </span></span></span></span></p> <p style="margin-top:0cm; margin-right:22.25pt; margin-bottom:10.0pt; margin-left:-.25pt; margin:0cm 22.8pt 0.15pt 0.5pt; text-align:justify"><span style="font-family:Arial,Helvetica,sans-serif;"><span style="font-size:16px;"><span style="line-height:149%"><span style="color:black">W Polsce w ostatnich 5 latach zaobserwowano statystycznie znamienny wzrost odsetka oporności wysokiego stopnia na aminoglikozydy u E. faecalis, z 41,2% w 2017r. do 55,2%<br /> w 2021r., co oznacza, że każda terapia skojarzona z użyciem aminoglikozydu w połączeniu<br /> z antybiotykiem beta-laktamowym lub glikopeptydem musi być poprzedzona oznaczeniem lekowrażliwości szczepu, który wywołał zakażenie. W przypadku E. faecium zaobserwowano utrzymywanie się wysokiego 34,3% odsetka oporności na wankomycynę. </span></span></span></span></p> <p style="margin-top:0cm; margin-right:22.25pt; margin-bottom:.15pt; margin-left:-.25pt; margin:0cm 22.8pt 0.15pt 0.5pt; text-align:justify"><span style="font-family:Arial,Helvetica,sans-serif;"><span style="font-size:16px;"><span style="line-height:149%"><span style="color:black">Stabilna sytuacja oporności na antybiotyki obserwowana jest w Polsce od wielu lat dla szczepów S. aureus. W 2021r. odsetek oporności na metycylinę u tego gatunku wynosił w Polsce 16,5% i jest niemal równy ze średnim odsetkiem MRSA dla krajów UE / EOG raportujących dane w sieci EARS-Net. Monitorowanie odsetka szczepów MRSA jest jednak bardzo istotne, ponieważ jest to drugi po E. coli szczepach opornych na cefalosporyny III generacji drobnoustrój powodujących największą liczbę zakażeń<br /> w grupie zakażeń wywoływanych przez bakterie oporne na antybiotyki w Europie. </span></span></span></span></p> <p style="margin:0cm; margin-bottom:.0001pt; text-align:justify"><span style="font-family:Arial,Helvetica,sans-serif;"><span style="font-size:16px;"><span style="line-height:107%"><span style="color:black"> </span></span></span></span></p> <p style="margin-top:0cm; margin-right:22.1pt; margin-bottom:6.25pt; margin-left:-.25pt; margin:0cm 22.8pt 0.15pt 0.5pt; text-align:justify"><span style="font-family:Arial,Helvetica,sans-serif;"><span style="font-size:16px;"><span style="line-height:103%"><span style="color:black"><span style="color:#1f497d">Konsumpcja antybiotyków w Polsce i Europie w 2020 roku na podstawie raportu sieci<br /> ESAC-Net z 2021 r. [6]  </span></span></span></span></span></p> <p style="margin-top:0cm; margin-right:22.25pt; margin-bottom:10.0pt; margin-left:-.25pt; margin:0cm 22.8pt 0.15pt 0.5pt; text-align:justify"><span style="font-family:Arial,Helvetica,sans-serif;"><span style="font-size:16px;"><span style="line-height:149%"><span style="color:black">Dane nt. konsumpcji antybiotyków monitorowane są w ramach Europejskiej Sieci Monitorowania Konsumpcji Antybiotyków ESAC-Net (ang. European Surveillance of Antimicrobial Consumption Network), koordynowanej przez ECDC.  Przedstawiane one są za pomocą wskaźnika dawek dobowych definiowanych DDD (ang. defined daily dose) na 1000 mieszkańców na dzień (DID) wg metodologii ATC/DDD opracowanej przez Ośrodek Statystyki Medycznej Światowej Organizacji Zdrowia. DDD jest rekomendowaną miarą umożliwiającą porównanie zużycia antybiotyków między różnymi krajami,  lub ośrodkami,  a także obserwację trendów konsumpcji.  </span></span></span></span></p> <p style="margin-top:0cm; margin-right:22.25pt; margin-bottom:6.05pt; margin-left:-.25pt; margin:0cm 22.8pt 0.15pt 0.5pt; text-align:justify"><span style="font-family:Arial,Helvetica,sans-serif;"><span style="font-size:16px;"><span style="line-height:149%"><span style="color:black">W 2021 r. przeciętne całkowite zużycie (łącznie w lecznictwie otwartym i zamkniętym) środków przeciwbakteryjnych do stosowania ogólnoustrojowego (grupa ATC J01)<br /> w UE/EOG wyniosło 16.4 DDD na 1000 mieszkańców na dzień (w poszczególnych krajach wahało się w przedziale 8,5–28,9). W latach 2011–2020 zaobserwowano istotny statystycznie spadek konsumpcji antybiotyków dla całej UE / EOG. Statystycznie istotne tendencje spadkowe zaobserwowano w dziewięciu krajach, tj. Belgia, Dania, Estonia, Finlandia, Włochy, Luksemburg, Holandia, Norwegia i Szwecja, natomiast wzrostowe<br /> w dwóch krajach: Bułgarii i na Cyprze.  </span></span></span></span></p> <p style="margin-top:0cm; margin-right:22.25pt; margin-bottom:5.85pt; margin-left:-.25pt; margin:0cm 22.8pt 0.15pt 0.5pt; text-align:justify"><span style="font-family:Arial,Helvetica,sans-serif;"><span style="font-size:16px;"><span style="line-height:149%"><span style="color:black">W Polsce w 2020 roku przeciętna konsumpcja środków przeciwbakteryjnych<br /> w lecznictwie otwartym wyniosła 17,1 DDD na 1000 mieszkańców na dzień, co na tle pozostałych  27 krajów oznaczało szóste miejsce pod względem najwyższej konsumpcji. W 2021 roku w Polsce spożycie antybiotyków w lecznictwie otwartym wyniosło 18,78 DDD na 1000 mieszkańców na dzień i było wyższe od średniej dla krajów UE / EOG, które wyniosło 15.0 DDD na 1000 mieszkańców na dzień, przy czym dla poszczególnych krajów notowano spożycie w zakresie od 7,2 do 24,1 DDD na 1000 mieszkańców na dzień. W lecznictwie zamkniętym Polska w 2020 roku znalazła się na siódmym miejscu (wśród 25 krajów raportujących dane z tego sektora) o najniższej konsumpcji, osiągając poziom konsumpcji 1,36 DDD na tysiąc mieszkańców na dzień. W 2021 roku w Polsce konsumpcja antybiotyków w sektorze szpitalnym wyniosła 1,37 DDD na 1000 mieszkańców na dzień, co odpowiadało średniej dla krajów UE / EOG, która wyniosła 1,4 DDD na 1000 mieszkańców na dzień Ponieważ dane z lecznictwa zamkniętego w raporcie ESAC-Net przeliczane są podobnie jak w lecznictwie otwartym na mieszkańców<br /> (a nie na pacjentów, ani osobodni hospitalizacji), dlatego interpretacja musi uwzględniać różną specyfikę lecznictwa zamkniętego w różnych krajach i porównania międzynarodowe w tym obszarze muszą być ostrożniejsze.  </span></span></span></span></p> <p style="margin-top:0cm; margin-right:22.25pt; margin-bottom:6.15pt; margin-left:0cm; margin:0cm 22.8pt 0.15pt 0.5pt; text-align:justify"> </p> <p style="margin-top:0cm; margin-right:22.25pt; margin-bottom:6.15pt; margin-left:-.25pt; margin:0cm 22.8pt 0.15pt 0.5pt; text-align:justify"><span style="font-family:Arial,Helvetica,sans-serif;"><span style="font-size:16px;"><span style="line-height:149%"><span style="color:black">Najnowszy raport z danymi dotyczącymi spożycia środków przeciwdrobnoustrojowych za rok 2021 nie zostały jeszcze opublikowane. Powyższe dane za lata 1997–2020 można znaleźć w ogólnodostępnej interaktywnej bazie danych ESAC-Net na stronie internetowej ECDC: <u style="text-underline:#76923c"><span style="color:#76923c">www.ecdc.europa.eu</span></u> . </span></span></span></span></p> <p style="margin-top:0cm; margin-right:0cm; margin-bottom:11.75pt; margin-left:0cm; margin:0cm 22.8pt 0.15pt 0.5pt; text-align:justify"><span style="font-family:Arial,Helvetica,sans-serif;"><span style="font-size:16px;"><span style="line-height:107%"><span style="color:black"><span style="color:#1f497d"> Niezbędne działania dla poprawy sytuacji </span></span></span></span></span></p> <p style="margin-top:0cm; margin-right:22.25pt; margin-bottom:.15pt; margin-left:-.25pt; margin:0cm 22.8pt 0.15pt 0.5pt; text-align:justify"><span style="font-family:Arial,Helvetica,sans-serif;"><span style="font-size:16px;"><span style="line-height:149%"><span style="color:black">Przeciwdziałanie zagrożeniom związanym z narastaniem antybiotykooporności wymaga wielosektorowych działań. Niezwykle ważne są kampanie edukacyjne na temat racjonalnej antybiotykoterapii i zapobiegania zakażeniom prowadzone w sposób ciągły i kierowane nie tylko do specjalistów medycznych, ale i do ogółu społeczeństwa. Konieczne są też szerokie działania w innych obszarach, takich jak wzmocnienie kontroli zakażeń, monitorowanie antybiotykooporności, zużycia antybiotyków i wprowadzanie procedur sprzyjających utrzymaniu efektywności dostępnych leków, właściwa polityka rejestracyjna i refundacyjna. Wreszcie ze względu na dynamikę zjawiska antybiotykooporności konieczne są inwestycje w prace nad wprowadzeniem nowych leków, strategii terapeutycznych, szczepień oraz narzędzi diagnostycznych, zwłaszcza tych nakierowanych na bakterie wielolekooporne („superbakterie”).  </span></span></span></span></p> <p style="margin-top:0cm; margin-right:0cm; margin-bottom:5.85pt; margin-left:0cm; margin:0cm 22.8pt 0.15pt 0.5pt; text-align:justify"><span style="font-family:Arial,Helvetica,sans-serif;"><span style="font-size:16px;"><span style="line-height:107%"><span style="color:black"> </span></span></span></span></p> <p style="margin-top:0cm; margin-right:22.1pt; margin-bottom:10.0pt; margin-left:-.25pt; margin:0cm 22.8pt 0.15pt 0.5pt; text-align:justify"><span style="font-family:Arial,Helvetica,sans-serif;"><span style="font-size:16px;"><span style="line-height:148%"><span style="color:black"><span style="color:#1f497d">PAMIĘTAJMY! Antybiotykooporność jest zagrożeniem dla zdrowia i życia nas wszystkich. Skuteczność antybiotyków, a więc możliwość leczenia zakażeń i chorób bakteryjnych zależy od rozsądnego ich stosowania.  </span></span></span></span></span></p> <p style="margin-top:0cm; margin-right:0cm; margin-bottom:15.7pt; margin-left:0cm; margin:0cm 22.8pt 0.15pt 0.5pt; text-align:justify"><span style="font-family:Arial,Helvetica,sans-serif;"><span style="font-size:16px;"><span style="line-height:107%"><span style="color:black"><span style="color:#548dd4">  <br /> <u style="text-underline:#548dd4">DOŁĄCZ DO KAMPANII: „Go Blue for AMR”:</u> </span></span></span></span></span></p> <ul> <li style="margin-top:0cm; margin-right:0cm; margin-bottom:10.5pt; margin:0cm 22.8pt 0.0001pt 36pt; text-align:justify"><span style="font-family:Arial,Helvetica,sans-serif;"><span style="font-size:16px;"><span style="line-height:148%"><span style="color:black"><span style="color:#548dd4">Noś jasnoniebieski kolor ubrań podczas WAAW i EAAD w dniach 18-24 listopada. </span></span></span></span></span></li> <li style="margin-top:0cm; margin-right:0cm; margin-bottom:10.5pt; margin:0cm 22.8pt 0.0001pt 36pt; text-align:justify"><span style="font-family:Arial,Helvetica,sans-serif;"><span style="font-size:16px;"><span style="line-height:148%"><span style="color:black"><span style="color:#548dd4">Podziel się ze światem! Użyj mediów społecznościowych i / lub tradycyjnych, aby ogłosić, dlaczego jesteś „Blue for AMR”. </span></span></span></span></span></li> <li style="margin-top:0cm; margin-right:0cm; margin-bottom:8.4pt; margin:0cm 22.8pt 0.0001pt 36pt; text-align:justify"><span style="font-family:Arial,Helvetica,sans-serif;"><span style="font-size:16px;"><span style="line-height:148%"><span style="color:black"><span style="color:#548dd4">Uświadamiaj o konieczności przeciwdziałania antybiotykooporności (AMR) przyjaciół, rodzinę współpracowników i swoją społeczność. </span></span></span></span></span></li> </ul> <p style="margin-top:0cm; margin-right:0cm; margin-bottom:8.4pt; margin-left:53.25pt; margin:0cm 22.8pt 0.15pt 36pt; text-align:justify"> </p> <p align="center" style="margin-top:0cm; margin-right:0cm; margin-bottom:11.45pt; margin-left:0cm; text-align:center; margin:0cm 22.8pt 0.15pt 0.5pt"><span style="font-family:Arial,Helvetica,sans-serif;"><span style="font-size:16px;"><span style="line-height:107%"><span style="color:black"><img alt="" height="295" src="https://chorzow.eu/download/cmVzb3VyY2VzL2ZpbGVzLzY4L2FudHliaW90eWtpX3NhbmVwaWRfNjM3NzZiODEzYWM2Mi5qcGc%3D" width="471" /></span></span></span></span></p> <p style="margin-top:0cm; margin-right:0cm; margin-bottom:.8pt; margin-left:0cm; margin:0cm 22.8pt 0.15pt 0.5pt; text-align:justify"><span style="font-family:Arial,Helvetica,sans-serif;"><span style="font-size:16px;"><span style="line-height:107%"><span style="color:black"> </span></span></span></span></p> <p style="margin-top:0cm; margin-right:22.65pt; margin-bottom:.0001pt; margin-left:0cm; margin:0cm 22.8pt 0.15pt 0.5pt; text-align:justify"><span style="font-family:Arial,Helvetica,sans-serif;"><span style="font-size:16px;"><span style="line-height:115%"><span style="color:black"><span style="color:#1f497d">Informacje na temat obchodów w Polsce kampanii informacyjnej Europejski Dzień Wiedzy o Antybiotykach oraz Światowy Tydzień Wiedzy o Antybiotykach dostępne są na stronie http://antybiotyki.edu.pl/edwa/  </span></span></span></span></span></p> <p style="margin-top:0cm; margin-right:0cm; margin-bottom:10.8pt; margin-left:0cm; margin:0cm 22.8pt 0.15pt 0.5pt; text-align:justify"><span style="font-family:Arial,Helvetica,sans-serif;"><span style="font-size:16px;"><span style="line-height:107%"><span style="color:black"> </span></span></span></span></p> <p style="margin-top:0cm; margin-right:0cm; margin-bottom:10.9pt; margin-left:0cm; margin:0cm 22.8pt 0.15pt 0.5pt; text-align:justify"><span style="font-family:Arial,Helvetica,sans-serif;"><span style="font-size:16px;"><span style="line-height:107%"><span style="color:black"> </span></span></span></span></p> <p style="margin:0cm; margin-bottom:.0001pt; text-align:justify"><span style="font-family:Arial,Helvetica,sans-serif;"><span style="font-size:16px;"><span style="line-height:107%"><span style="color:black"><span style="line-height:107%">Piśmiennictwo:  </span></span></span></span></span></p> <ol> <li style="margin-top:0cm; margin-right:22.0pt; margin-bottom:.2pt; margin:0cm 22.8pt 0.15pt 0.5pt; text-align:justify"><span style="font-family:Arial,Helvetica,sans-serif;"><span style="font-size:16px;"><span style="line-height:103%"><span style="color:black"><span style="line-height:103%"><span style="color:#0d0d0d">Antimicrobial Resistance Collaborators. (2022). Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis. The Lancet; 399: P629-655. DOI: <u style="text-underline:#0d0d0d">https://doi.org/10.1016/S01406736(21)02724-0</u>  </span></span></span></span></span></span></li> <li style="margin-top:0cm; margin-right:22.0pt; margin-bottom:.2pt; margin:0cm 22.8pt 0.15pt 0.5pt; text-align:justify"><span style="font-family:Arial,Helvetica,sans-serif;"><span style="font-size:16px;"><span style="line-height:103%"><span style="color:black"><span style="line-height:103%"><span style="color:#0d0d0d">https://ahpsr.who.int/publications/i/item/global-action-plan-on-antimicrobial-resistance </span></span></span></span></span></span></li> <li style="margin-top:0cm; margin-right:22.0pt; margin-bottom:.2pt; margin:0cm 22.8pt 0.15pt 0.5pt; text-align:justify"><span style="font-family:Arial,Helvetica,sans-serif;"><span style="font-size:16px;"><span style="line-height:103%"><span style="color:black"><span style="line-height:103%"><span style="color:#0d0d0d">European Antibiotic Awareness Day (EAAD) 2022 (europa.eu) </span></span></span></span></span></span></li> <li style="margin-top:0cm; margin-right:22.0pt; margin-bottom:.2pt; margin:0cm 22.8pt 0.15pt 0.5pt; text-align:justify"><span style="font-family:Arial,Helvetica,sans-serif;"><span style="font-size:16px;"><span style="line-height:103%"><span style="color:black"><span style="line-height:103%"><span style="color:#0d0d0d">https://www.who.int/campaigns/world-antimicrobial-awareness-week/2022 </span></span></span></span></span></span></li> <li style="margin-top:0cm; margin-right:22.0pt; margin-bottom:.2pt; margin:0cm 22.8pt 0.15pt 0.5pt; text-align:justify"><span style="font-family:Arial,Helvetica,sans-serif;"><span style="font-size:16px;"><span style="line-height:103%"><span style="color:black"><span style="line-height:103%"><span style="color:#0d0d0d">Antimicrobial resistance in the EU/EEA (EARS-Net) - Annual Epidemiological Report for 2021 (europa.eu) </span></span></span></span></span></span></li> <li style="margin-top:0cm; margin-right:22.0pt; margin-bottom:.2pt; margin:0cm 22.8pt 0.15pt 0.5pt; text-align:justify"><span style="font-family:Arial,Helvetica,sans-serif;"><span style="font-size:16px;"><span style="line-height:103%"><span style="color:black"><span style="line-height:103%"><span style="color:#0d0d0d">http://atlas.ecdc.europa.eu/public/Antimicrobial consumption in the EU/EEA (ESAC-Net) - Annual Epidemiological Report for 2020 (europa.e</span></span></span></span></span></span></li> </ol> <p style="margin-top:0cm; margin-right:22.0pt; margin-bottom:.2pt; margin:0cm 22.8pt 0.15pt 0.5pt; text-align:justify"> </p>2022-11-18 12:26:442022-11-18 12:26:44