Understanding the mechanisms and drivers of antimicrobial resistance
Understanding the mechanisms and drivers of antimicrobial resistance
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DOI：
10.1016/s0140-6736(15)00473-0
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发表时间：
2016-01-09
期刊：
影响因子：
168.9
通讯作者：
Piddock, Laura J. V.
中科院分区：
文献类型：
--
作者：
Holmes, Alison H.;Moore, Luke S. P.;Piddock, Laura J. V.
为了应对抗菌素耐药性对人类健康和生物安全的威胁，需要了解其机制和驱动因素。微生物中出现抗菌素耐药性是一种自然现象，但抗菌素耐药性选择是由医疗保健、农业和环境中的抗菌素暴露驱动的。感染控制、卫生、获得清洁水、获得有保证质量的抗微生物剂和诊断、旅行和移徙的标准会影响继续传播。通过单独消除抗菌药物选择压力来降低抗菌药物耐药性的策略依赖于耐药性带来的适应性成本，但这种效果并不总是明显的。因此，应通过耐药机制、微生物、抗菌药物、宿主和环境综合考虑最大限度地减少耐药性;与新药发现平行，需要在这五个层面进行广泛的多学科研究，并在卫生保健、农业和环境部门之间相互联系。需要采取明智、综合的方法，注意潜在的意外结果，以确保全球可持续获得有效的抗菌药物。
To combat the threat to human health and biosecurity from antimicrobial resistance, an understanding of its mechanisms and drivers is needed. Emergence of antimicrobial resistance in microorganisms is a natural phenomenon, yet antimicrobial resistance selection has been driven by antimicrobial exposure in health care, agriculture, and the environment. Onward transmission is aff ected by standards of infection control, sanitation, access to clean water, access to assured quality antimicrobials and diagnostics, travel, and migration. Strategies to reduce antimicrobial resistance by removing antimicrobial selective pressure alone rely upon resistance imparting a fi tness cost, an eff ect not always apparent. Minimising resistance should therefore be considered comprehensively, by resistance mechanism, microorganism, antimicrobial drug, host, and context; parallel to new drug discovery, broad ranging, multidisciplinary research is needed across these fi ve levels, interlinked across the health-care, agriculture, and environment sectors. Intelligent, integrated approaches, mindful of potential unintended results, are needed to ensure sustained, worldwide access to eff ective antimicrobials.