Transferable resistance to colistin: a new but old threat
Transferable resistance to colistin: a new but old threat
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DOI：
10.1093/jac/dkw274
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发表时间：
2016-08-01
影响因子：
5.2
通讯作者：
Johnson, Alan P.
中科院分区：
文献类型：
--
作者：
Schwarz, Stefan;Johnson, Alan P.
大肠杆菌中编码粘菌素抗性的 mcr-1 基因自 20 世纪 80 年代以来就已存在，似乎无处不在，并且可能已在动物部门中出现，但减少其进一步传播的干预措施将需要采取综合的全球单一健康方法。 在这篇领先文章中，我们总结了目前关于第一个也是迄今为止唯一一个可转移粘菌素抗性基因 mcr-1 出现的知识。它在接合质粒上的位置可能促使其传播到人类和动物的一系列肠道细菌中。筛查研究已在七大洲中的五大洲中发现了 mcr-1，中国的回顾性研究已在 20 世纪 80 年代首次分离出的大肠杆菌中发现了该基因，而第一个欧洲分离株可追溯到 2005 年。基于多个国家在猪和家禽中广泛使用粘菌素，以及动物来源的携带 mcr-1 的分离株数量高于人类来源，人们很容易认为这种耐药性可能已在动物中出现部门。无论其起源如何，减少其进一步传播的干预措施都需要采取综合的全球单一健康方法，包括强有力的抗生素管理以减少不必要的粘菌素使用，改善感染预防，以及控制和监测兽医和人类医学中粘菌素的使用和耐药性。
The mcr-1 gene encoding colistin resistance in Escherichia coli has been around since the 1980s, appears to be ubiquitous and may have emerged in the animal sector, but interventions to reduce its further spread will require an integrated global one-health approach.In this Leading article, we summarize current knowledge of the occurrence of the first and so far only transferable colistin resistance gene, mcr-1. Its location on a conjugative plasmid is likely to have driven its spread into a range of enteric bacteria in humans and animals. Screening studies have identified mcr-1 in five of the seven continents and retrospective studies in China have identified this gene in Escherichia coli originally isolated in the 1980s, while the first European isolate dates back to 2005. Based on the widespread use of colistin in pigs and poultry in several countries and the higher number of mcr-1-carrying isolates of animal origin than of human origin, it is tempting to assume that this resistance may have emerged in the animal sector. Whatever its origin, interventions to reduce its further spread will require an integrated global one-health approach, comprising robust antibiotic stewardship to reduce unnecessary colistin use, improved infection prevention, and control and surveillance of colistin usage and resistance in both veterinary and human medicine.