Antimicrobial Resistance: a One Health Perspective
Antimicrobial Resistance: a One Health Perspective
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DOI：
10.1128/microbiolspec.arba-0009-2017
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发表时间：
2018-01-01
期刊：
影响因子：
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通讯作者：
Collignon, Peter J.
中科院分区：
文献类型：
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作者：
McEwen, Scott A.;Collignon, Peter J.
“同一个健康”是多个健康科学专业人士的共同努力，旨在为人类、家畜、野生动物、植物和我们的环境实现最佳健康。抗菌药物耐药性的驱动因素包括人类、动物和环境部门中抗菌药物的使用和滥用，以及这些部门内部和之间以及全球范围内耐药细菌和耐药性决定因素的传播。大多数用于治疗人类细菌感染的抗菌药物也可用于动物。鉴于抗菌素耐药性对人类、动物和环境的重要且相互依存的影响，在解决这一问题时采取“同一个健康”方法是合乎逻辑的。这包括采取措施，通过消除现有抗菌药物的不当使用和限制感染传播，保持现有抗菌药物的持续有效性。动物健康和农业部门的主要问题是对动物大量使用对人类至关重要的抗菌药物，如第三代头孢菌素和氟喹诺酮类药物，以及在饲料中长期使用具有医学意义的抗菌药物，如粘菌素、四环素和大环内酯类药物，以促进生长。在人类领域，预防感染、减少抗菌药物的过度处方、改善环境卫生以及改善个人卫生和感染控制至关重要。工业、住宅和农场废物处理不当造成的污染正在扩大环境中的耐药性。许多国家和一些国际机构已将“同一个健康”方法纳入其解决抗菌素耐药性的行动计划中。必要的行动包括改进抗菌药物使用监管和政策、监测、管理、感染控制、卫生、畜牧业和抗菌药物替代品。世界卫生组织最近发布了关于在食用动物中使用具有重要医学意义的抗菌药物的新指南，建议农民和食品工业停止常规使用抗菌药物来促进健康动物的生长和预防疾病。这些指南旨在通过减少对动物的使用来帮助保持对人类医学重要的抗菌药物的有效性。
One Health is the collaborative effort of multiple health science professions to attain optimal health for people, domestic animals, wildlife, plants, and our environment. The drivers of antimicrobial resistance include antimicrobial use and abuse in human, animal, and environmental sectors and the spread of resistant bacteria and resistance determinants within and between these sectors and around the globe. Most of the classes of antimicrobials used to treat bacterial infections in humans are also used in animals. Given the important and interdependent human, animal, and environmental dimensions of antimicrobial resistance, it is logical to take a One Health approach when addressing this problem. This includes taking steps to preserve the continued effectiveness of existing antimicrobials by eliminating their inappropriate use and by limiting the spread of infection. Major concerns in the animal health and agriculture sectors are mass medication of animals with antimicrobials that are critically important for humans, such as third-generation cephalosporins and fluoroquinolones, and the long-term, in-feed use of medically important antimicrobials, such as colistin, tetracyclines, and macrolides, for growth promotion. In the human sector it is essential to prevent infections, reduce over-prescribing of antimicrobials, improve sanitation, and improve hygiene and infection control. Pollution from inadequate treatment of industrial, residential, and farm waste is expanding the resistome in the environment. Numerous countries and several international agencies have included a One Health approach within their action plans to address antimicrobial resistance. Necessary actions include improvements in antimicrobial use regulation and policy, surveillance, stewardship, infection control, sanitation, animal husbandry, and alternatives to antimicrobials. WHO recently has launched new guidelines on the use of medically important antimicrobials in food-producing animals, recommending that farmers and the food industry stop using antimicrobials routinely to promote growth and prevent disease in healthy animals. These guidelines aim to help preserve the effectiveness of antimicrobials that are important for human medicine by reducing their use in animals.