A One Health approach to antimicrobial resistance surveillance: is there a business case for it?
A One Health approach to antimicrobial resistance surveillance: is there a business case for it?
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DOI：
10.1016/j.ijantimicag.2016.06.014
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发表时间：
2016-10-01
影响因子：
10.8
通讯作者：
Rushton, Jonathan
中科院分区：
文献类型：
--
作者：
Queenan, Kevin;Hasler, Barbara;Rushton, Jonathan
抗生素耐药性是一个复杂的流行病学全球性问题，适合广泛、综合的“同一个健康”方法。人类、动物、食物和环境中存在耐药生物体，而这种耐药性的主要驱动因素是抗菌药物的使用。提出了一个“One Health”监测概念框架，其中包括所有这些方面。描述了全球和欧洲（区域和国家）监测系统，并强调了与该框架相比的缺点。政策决策依赖于经济和科学证据，因此提出了完全集成系统的商业案例。综合监测的成本被不受控制的抵抗的成本以及干预措施和结果带来的好处所抵消。目前的估计侧重于人类健康结果的成本和效益。 One Health 评估包括劳动力流失带来的更广泛的社会成本、寻求健康行为的变化、对动物健康和福利的影响、动物源性食品生产成本上升以及消费者对此类食品安全和国际贸易的信心下降。监测的好处可能需要数年时间才能实现，并且取决于有效且可接受的干预措施。还应认识到好处，包括无形的好处，例如服务交付方面协同作用和效率的提高以及更及时和准确的风险识别。通过将这些无形的社会效益、动物福利、生态系统健康和复原力纳入其中，再加上通过共享资源和社会资本建设实现的节约和效率，可以为“同一个健康”监测方法提供更强有力的商业案例。 (C) 2016 Elsevier B.V. 和国际化疗协会。版权所有。
Antimicrobial resistance is a global problem of complex epidemiology, suited to a broad, integrated One Health approach. Resistant organisms exist in humans, animals, food and the environment, and the main driver of this resistance is antimicrobial usage. A One Health conceptual framework for surveillance is presented to include all of these aspects. Global and European (regional and national) surveillance systems are described, highlighting shortcomings compared with the framework. Policy decisions rely on economic and scientific evidence, so the business case for a fully integrated system is presented. The costs of integrated surveillance are offset by the costs of unchecked resistance and the benefits arising from interventions and outcomes. Current estimates focus on costs and benefits of human health outcomes. A One Health assessment includes wider societal costs of lost labour, changes in health-seeking behaviour, impacts on animal health and welfare, higher costs of animal-origin food production, and reduced consumer confidence in safety and international trade of such food. Benefits of surveillance may take years to realise and are dependent on effective and accepted interventions. Benefits, including the less tangible, such as improved synergies and efficiencies in service delivery and more timely and accurate risk identification, should also be recognised. By including these less tangible benefits to society, animal welfare, ecosystem health and resilience, together with the savings and efficiencies through shared resources and social capital-building, a stronger business case for a One Health approach to surveillance can be made. (C) 2016 Elsevier B.V. and International Society of Chemotherapy. All rights reserved.