Antimicrobial drug use in food-producing animals and associated human health risks: what, and how strong, is the evidence?
Antimicrobial drug use in food-producing animals and associated human health risks: what, and how strong, is the evidence?
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DOI：
10.1186/s12917-017-1131-3
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发表时间：
2017-07-04
影响因子：
2.6
通讯作者：
Coukell A
中科院分区：
文献类型：
--
作者：
Hoelzer K;Wong N;Thomas J;Talkington K;Jungman E;Coukell A
抗菌素耐药性是对公共健康的威胁。由于食用动物的抗菌剂消费导致了这一问题，因此限制在农业中不适当或不必要地使用抗菌药的政策很重要。然而，农业抗生素使用和抗生素耐药性之间的这种联系仍然受到一些人的质疑，可能会对明智或谨慎使用这些药物的努力产生破坏性影响。这项审查的目标是系统地评估从农场使用抗菌剂到人类公共健康风险的因果途径中每一步可用的证据类型，并在“建议评估、发展和评价等级”(GRADE)框架内评估证据的强度。审查清楚地表明，有令人信服的科学证据支持因果途径中的每一步，从农场使用抗菌剂到感染耐药病原体造成的公共卫生负担。重要的是，病原体、抗菌药物和治疗方案以及一般环境(例如，饲料类型)可能对耐药性产生或传播的速度、抗生素暴露停止后耐药性可能持续多长时间以及农场使用抗生素可能对公共健康造成什么影响产生重大影响。因此，与其他来源相比，准确量化畜牧业使用抗微生物药物对公众健康造成的负担仍然具有挑战性。尽管需要进行更多的研究来弥合现有的数据差距，更好地了解农场或饲养场实际如何使用抗菌药，并量化动物农业中使用抗菌剂的风险，但这些发现强化了现在采取行动的必要性，将动物农业中抗生素的使用限制在确保动物健康和福祉所必需的情况下。
Antimicrobial resistance is a public health threat. Because antimicrobial consumption in food-producing animals contributes to the problem, policies restricting the inappropriate or unnecessary agricultural use of antimicrobial drugs are important. However, this link between agricultural antibiotic use and antibiotic resistance has remained contested by some, with potentially disruptive effects on efforts to move towards the judicious or prudent use of these drugs. The goal of this review is to systematically evaluate the types of evidence available for each step in the causal pathway from antimicrobial use on farms to human public health risk, and to evaluate the strength of evidence within a ‘Grades of Recommendations Assessment, Development and Evaluation‘(GRADE) framework. The review clearly demonstrates that there is compelling scientific evidence available to support each step in the causal pathway, from antimicrobial use on farms to a public health burden caused by infections with resistant pathogens. Importantly, the pathogen, antimicrobial drug and treatment regimen, and general setting (e.g., feed type) can have significant impacts on how quickly resistance emerges or spreads, for how long resistance may persist after antimicrobial exposures cease, and what public health impacts may be associated with antimicrobial use on farms. Therefore an exact quantification of the public health burden attributable to antimicrobial drug use in animal agriculture compared to other sources remains challenging. Even though more research is needed to close existing data gaps, obtain a better understanding of how antimicrobial drugs are actually used on farms or feedlots, and quantify the risk associated with antimicrobial use in animal agriculture, these findings reinforce the need to act now and restrict antibiotic use in animal agriculture to those instances necessary to ensure the health and well-being of the animals.