醫學術語是學習醫學知識的基礎和前提。公眾號推出「醫學雙語術語」欄目，每一期擬採用英漢對照的模式，以雙語的形式科普醫學知識，同時也為醫學英語與翻譯專業人士提供學習素材。文中標有背景色的部分文字涉及通用學術英語和醫學專門學術英語學習過程中常用的單詞及短語表達等問題。
What is antimicrobial resistance (AMR)？
什麼是抗微生物藥物耐藥性？
Antimicrobial resistance (AMR) is resistance of a microorganism to an antimicrobial drug that was originally effective for treatment of infections caused by it. It is the broader term for resistance in different types of microorganisms and encompasses resistance to antibacterial, antiviral, antiparasitic and antifungal drugs. It is different from antibiotic resistance, which refers specifically to the resistance to antibiotics that occurs in common bacteria that cause infections.
抗微生物藥物耐藥性指微生物對原本能夠有效治療其所引起的感染的抗微生物藥物產生抵抗性。抗微生物藥物耐藥性是不同類型微生物存在耐藥性的廣義術語，它包括對抗細菌、抗病毒、抗寄生蟲和抗真菌藥物產生的耐藥性。它不同於抗生素耐藥性，因為後者專指引起感染的普通細菌所出現的對抗生素的耐藥性。
Antimicrobial resistance is facilitated by the inappropriate use of medicines, for example, when taking substandard doses or not finishing a prescribed course of treatment. Low-quality medicines, wrong prescriptions and poor infection prevention and control also encourage the development and spread of drug resistance. Lack of government commitment to address these issues, poor surveillance and a diminishing arsenal of tools to diagnose, treat and prevent also hinder the control of antimicrobial drug resistance.
藥物使用不當很容易造成抗微生物藥物耐藥性，例如當劑量低於標準或未完成規定的療程時。劣質藥物、錯誤的處方和欠佳的感染控制也會推動耐藥性的形成和傳播。政府不能致力於解決這些問題，監測薄弱以及用於診斷、治療和預防的工具減少，也會阻礙對抗菌素耐藥性的控制。
Key facts
Antimicrobial resistance threatens the effective prevention and treatment of an ever-increasing range of infections caused by bacteria, parasites, viruses and fungi.
抗微生物藥物耐藥性威脅到由細菌、寄生蟲、病毒和真菌引起的越來越多種感染的有效預防和治療。
It is an increasingly serious threat to global public health that requires action across all government sectors and society.
它對全球公共衛生構成越來越嚴重的威脅，需要所有政府部門和全社會都採取行動。
Antimicrobial resistance is present in all parts of the world. New resistance mechanisms emerge and spread globally.
全世界各地都存在抗微生物藥物耐藥性。新的耐藥機制出現並傳播全球。
Patients with infections caused by drug-resistant bacteria are generally at increased risk of worse clinical outcomes and death, and consume more health-care resources than patients infected with the same bacteria that are not resistant.
一般而言，由耐藥細菌引起感染的患者比感染不耐藥的同一種細菌的患者面臨出現更差臨床結果和死亡的更高風險，也會消耗更多衛生保健資源。
Present situation
Resistance in bacteria 細菌耐藥
WHO’s 2014 report on global surveillance of antimicrobial resistance revealed that antibiotic resistance is no longer a prediction for the future; it is happening right now, across the world, and is putting at risk the ability to treat common infections in the community and hospitals. Without urgent, coordinated action, the world is heading towards a post-antibiotic era, in which common infections and minor injuries, which have been treatable for decades, can once again kill.
世衛組織2014年抗微生物藥物耐藥性全球監測報告指出，抗生素耐藥性再也不是對未來的預測，而是全世界正在發生的現實，而且正在威脅人類治療醫院和社區中普通感染的能力。如果不緊急採取協調行動，全世界就可能會進入後抗生素時代——幾十年來可以治療的普通感染和小傷會再次變得致命。
Treatment failure to the drug of last resort for gonorrhoea – third-generation cephalosporins – has been confirmed in several countries. Untreatable gonococcal infections result in increased rates of illness and complications, such as infertility, adverse pregnancy outcomes and neonatal blindness, and has the potential to reverse the gains made in the control of this sexually transmitted infection.
多個國家已確認，由於對治療淋病的最後手段（三代頭孢菌素）耐藥，導致治療失敗。無法治療的淋球菌感染導致不育、不良妊娠結局和新生兒失明等疾病和併發症發病率上升，還有可能逆轉在控制這種性傳播感染方面所取得的成就。
Resistance to one of the most widely used antibacterial drugs for the oral treatment of urinary tract infections caused by E.coli – fluoroquinolones – is very widespread.
氟喹諾酮類藥物是最廣泛使用的治療大腸桿菌引起的尿道感染的口服抗菌藥之一，對該藥的耐藥非常普遍。
Resistance to first-line drugs to treat infections caused by Staphylococcus aureus – a common cause of severe infections acquired both in health-care facilities and in the community – is also widespread.
金黃色葡萄球菌是在衛生保健設施和社區獲得的嚴重感染的常見原因，而對治療其所引起的感染的一線藥物耐藥也非常普遍。
Resistance to the treatment of last resort for life-threatening infections caused by common intestinal bacteria – carbapenem antibiotics – has spread to all regions of the world. Key tools to tackle antibiotic resistance – such as basic systems to track and monitor the problem – reveal considerable gaps. In many countries, they do not even seem to exist.
碳青黴烯類抗生素是治療常見腸道細菌引起的威脅生命的感染的最後手段，對此類藥物的耐藥性已經傳播到世界各區域。應對抗生素耐藥性的重要工具（如跟蹤和監測該問題的基本制度）方面還存在重大欠缺。許多國家甚至不存在此類工具。
Resistance in tuberculosis 結核病耐藥
In 2013, there were an estimated 480 000 new cases of MDR-TB in the world. Globally, 3.5% of new TB cases and 20.5% of previously treated TB cases are estimated to have MDR-TB, with substantial differences in the frequency of MDR-TB among countries. Extensively drug-resistant TB has been identified in 100 countries, in all regions of the world.
2013年，估計全世界共有48萬例新發耐多藥結核病。從全球看，3.5%的新髮結核病例和20.5%曾接受治療的病例為耐多藥結核病，但各國耐多藥結核病出現的頻率差別很大。全世界各區域共有100個國家發現了廣泛耐藥結核病。
Resistance in malaria 瘧疾耐藥
The emergence of P. falciparum multidrug resistance, including resistance to Artemisinin Combination Therapies(ACTs), in the Greater Mekong subregion is an urgent public health concern that is threatening the ongoing global effort to reduce the burden of malaria. Routine monitoring of therapeutic efficacy is essential to guide and adjust treatment policies. It can also help to detect early changes in P. falciparum sensitivity to antimalarial drugs.
大湄公河次區域出現耐青蒿素（包括以青蒿素為基礎的聯合療法）的惡性瘧原蟲是一個緊急公共衛生關切，威脅到全球減少瘧疾負擔的努力。要指導並調整治療政策，對治療效果進行常規監測必不可少。監測還有助於及早發現惡性瘧原蟲對抗瘧藥敏感性的變化。
Resistance in HIV 愛滋病毒耐藥
HIV drug resistance emerges when HIV replicates in the body of a person infected with the virus who is taking antiretroviral drugs. Even when antiretroviral therapy (ART) programmes are very well-managed, some degree of HIV drug resistance will emerge.
在愛滋病毒感染者服用抗逆轉錄病毒藥物期間病毒在感染者體內複製，就會出現愛滋病毒耐藥性。就算抗逆轉錄病毒治療方案得到了非常完善的管理，還會出現一定程度的愛滋病毒耐藥性。
HIV drug resistance may rise to such a level that the first-line and second-line ART regimens currently used to treat HIV become ineffective, jeopardizing people’s lives and threatening national and global investments in ART programmes.
愛滋病毒耐藥性有可能達到更高水平，使目前用於治療愛滋病的一線和二線抗逆轉錄病毒治療方法失去效果，對人的生命造成危害並威脅到國家和全球對抗逆轉錄病毒治療的投入效果。
Continuous surveillance of HIV drug resistance is of paramount importance to inform global and national decisions on the selection of first and second-line ART and to maximize overall population level treatment effectiveness.
持續監測愛滋病毒耐藥性對全球和國家對一線和二線抗逆轉錄病毒治療做出選擇以及人口總體治療效果最大化具有重要意義。
Resistance in influenza 流感耐藥
Over the past 10 years, antiviral drugs have become important tools for treatment of epidemic and pandemic influenza. Several countries have developed national guidance on their use and have stockpiled the drugs for pandemic preparedness. The constantly evolving nature of influenza means that resistance to antiviral drugs is continuously emerging.
過去十年間，抗病毒藥物已經成為治療流行性和大流行性流感的重要工具。多個國家就其使用制定了國家指導文件，並為防範大流行儲備了藥品。流感不斷演化的特性就決定了對抗病毒藥物的耐藥性也不斷出現。
Prevention and control 預防與控制
Antimicrobial resistance is a complex problem driven by many interconnected factors. As such, single, isolated interventions have little impact. Coordinated action is required to minimize emergence and spread of antimicrobial resistance.
抗微生物藥物耐藥性是多個相互關聯因素共同造成的複雜問題，因此單一、孤立的幹預措施效果不大。需要各方協調行動，以便儘量減少抗微生物藥物耐藥性的出現和蔓延。
People can help tackle resistance by:
要應對耐藥性問題，人們應：
-hand washing, and avoiding close contact with sick people to prevent transmission of bacterial infections and viral infections such as influenza or rotavirus, and using condoms to prevent the transmission of sexually-transmitted infections;
洗手，避免與病人發生密切接觸以防止流感或輪狀病毒等細菌感染和病毒感染，使用保險套防止性傳播感染的發生；
-getting vaccinated, and keeping vaccinations up to date;
接種疫苗，保持疫苗接種的及時狀態；
-using antimicrobial drugs only when they are prescribed by a certified health professional;
僅在有資質的衛生專業人員開具處方的情況下使用抗微生物藥物；
-completing the full treatment course (which in the case of antiviral drugs may require life-long treatment), even if they feel better;
即使感覺好轉，也要完成整個療程（抗病毒藥物可能需要終身治療的情況下）；
-never sharing antimicrobial drugs with others or using leftover prescriptions.
不與他人共用抗微生物藥物，不使用剩餘的處方藥。
Health workers and pharmacists can help tackle resistance by:
要應對耐藥性問題，衛生工作者和藥劑師應：
-enhancing infection prevention and control in hospitals and clinics;
醫院和診所加強感染預防和控制；
-only prescribing and dispensing antibiotics when they are truly needed;
只有在真正需要時才開具處方和提供抗生素；
-prescribing and dispensing the right antimicrobial drugs to treat the illness.
處方並提供治療疾病的正確抗微生物藥物。
Policymakers can help tackle resistance by:
要應對耐藥性問題，政策制定者應：
-improving monitoring around the extent and causes of resistance;
改善對耐藥性程度和原因的監測；
-strengthening infection control and prevention;
加強感染控制和預防；
-regulating and promoting appropriate use of medicines;
管理和促進藥品正確使用；
-making information widely available on the impact of antimicrobial resistance and how the public and health professionals can play their part;
擴大有關抗微生物藥物耐藥性影響信息的可獲得範圍，告知公眾和衛生專業人員如何發揮作用；
-rewarding innovation and development of new treatment options and other tools.
獎勵新治療手段和工具的創新與開發。
重點醫學單詞及詞彙匯總
1. microbe [ˈmaɪkrəʊb] n. 微生物，細菌
2. antimicrobial resistance [,æntɪmaɪ'krəʊbɪəl rɪ'zɪst(ə)ns] 抗微生物藥物耐藥性
3. antimicrobial [,æntɪmaɪ'krəʊbɪəl] adj. 抗微生物的，抗菌的
4. antibiotic [ˌæntibaɪˈɒtɪk] n. 抗生素，抗菌素
5. antifungal [ˌæntɪ'fʌŋgəl] adj. 抗真菌的，殺真菌的
6. strain [streɪn] n.（病菌的）類型；（植物或其他有機物的）品種
7. vaccination [,væksɪ'neɪʃən] n. 疫苗接種
8. prescribe [prɪ'skraɪb] v. 開處方
9. pharmacist ['fɑːməsɪst] n. 藥劑師
10. parasite ['pærəsaɪt] n. 寄生蟲
11. infection [ɪnˈfekʃn] n. 感染
12. gonorrhoea [ˌɡɒnəˈrɪə] n. 淋病
13. Staphylococcus aureus [ˌstæfɪləˈkɒkəs 'ɔ:rɪəs] n. 金黃色葡萄球菌
14. intestinal [ˌɪntes'taɪnl] adj. 腸的，腸道的
15. fluoroquinolone [flʊərəʊkwaɪnə'ləʊn] n. 氟喹諾酮類藥物
Further imformation:
The fluoroquinolones are a family of broad spectrum, systemic antibacterial agents that have been used widely as therapy of respiratory and urinary tract infections. 廣譜的氟喹諾酮類原料藥是一個已廣泛應用於治療呼吸道和尿路感染的系統的抗菌藥物家族。（來源：Livertox）
16. P. falciparum n. 惡性瘧原蟲
17. antiretroviral therapy [ˌæntɪˌretrəʊ'vaɪrəl ˈθerəpi ] n.抗逆轉錄病毒治療
18. influenza [ˌɪnfluˈenzə] n. 流感
注：英漢文字材料整理來自WHO官網