Antibiotic resistance as a global threat: Evidence from China, Kuwait and the United States
Antibiotic resistance as a global threat: Evidence from China, Kuwait and the United States
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DOI：
10.1186/1744-8603-2-6
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发表时间：
2006-01-01
影响因子：
10.8
通讯作者：
Zeckhauser, Richard J.
中科院分区：
文献类型：
--
作者：
Zhang, Ruifang;Eggleston, Karen;Zeckhauser, Richard J.
背景：抗菌素耐药性是地球仪各国公共卫生的一个未被充分认识的威胁。随着全球化的蓬勃发展，重要的是要了解国际抵抗模式。如果各国已经经历了类似的耐药模式，那么担心国际传播可能为时已晚。如果有可能在与世界其他地区的融合中取得飞跃的大国或国家集团（中国是一个突出的例子）具有高度和独特的耐药性模式，那么协调一致的反应可以大大有助于控制耐药性的蔓延。迄今为止的文献只提供了有限的证据对这些issues.Methods：我们研究了最近的模式，抗生素耐药性在三个地理上分离，文化和经济上不同的国家-中国，科威特和美国-来衡量的范围和深度，这一全球健康威胁，其增长潜力，随着全球化的扩大。我们的主要措施是特定细菌对特定抗生素的耐药性。我们还提出并说明了聚合特定的“错误药物”数据的方法。我们使用这些综合指标来总结每个国家的耐药性模式，并研究各国耐药性模式之间的相关程度。结果：我们发现中国的抗生素耐药性水平最高，其次是科威特和美国。S.在1999年和2001年对中国几种最常见细菌的耐药模式进行的一项研究中，医院获得性感染的平均耐药率高达41%（范围为23%-77%），社区获得性感染的平均耐药率为26%（范围为15%-39%）。中国也有最快的耐药增长率（1994年至2000年的一项研究中平均增长22%）。科威特位居第二（1999年至2003年平均增长17%），而美国、英国和英国则位居第三。S.最低（1999年至2002年为6%）。这三个国家的耐药模式并不高度相关;相关性最强的是中国和科威特，其次是科威特和美国。美国，相关性最低的是中国和美国。结论：抗菌素耐药性在这三个国家都是一个严重且日益严重的问题。迄今为止，各国的抵抗模式在国际上没有很大的一致性。这一发现可能会随着全球化带来的更大的国际旅行而改变。今后应优先研究耐药模式的决定因素及其国际趋同或差异。
Background: Antimicrobial resistance is an under-appreciated threat to public health in nations around the globe. With globalization booming, it is important to understand international patterns of resistance. If countries already experience similar patterns of resistance, it may be too late to worry about international spread. If large countries or groups of countries that are likely to leap ahead in their integration with the rest of the world China being the standout case - have high and distinctive patterns of resistance, then a coordinated response could substantially help to control the spread of resistance. The literature to date provides only limited evidence on these issues.Methods: We study the recent patterns of antibiotic resistance in three geographically separated, and culturally and economically distinct countries - China, Kuwait and the United States - to gauge the range and depth of this global health threat, and its potential for growth as globalization expands. Our primary measures are the prevalence of resistance of specific bacteria to specific antibiotics. We also propose and illustrate methods for aggregating specific "bug-drug" data. We use these aggregate measures to summarize the resistance pattern for each country and to study the extent of correlation between countries' patterns of drug resistance.Results: We find that China has the highest level of antibiotic resistance, followed by Kuwait and the U. S. In a study of resistance patterns of several most common bacteria in China in 1999 and 2001, the mean prevalence of resistance among hospital-acquired infections was as high as 41% (with a range from 23% to 77%) and that among community-acquired infections was 26% (with a range from 15% to 39%). China also has the most rapid growth rate of resistance (22% average growth in a study spanning 1994 to 2000). Kuwait is second (17% average growth in a period from 1999 to 2003), and the U. S. the lowest (6% from 1999 to 2002). Patterns of resistance across the three countries are not highly correlated; the most correlated were China and Kuwait, followed by Kuwait and the U. S., and the least correlated pair was China and the U. S.Conclusion: Antimicrobial resistance is a serious and growing problem in all three countries. To date, there is not strong international convergence in the countries' resistance patterns. This finding may change with the greater international travel that will accompany globalization. Future research on the determinants of drug resistance patterns, and their international convergence or divergence, should be a priority.