Antimicrobial Resistance
Antimicrobial Resistance
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DOI：
10.1001/jama.2016.11764
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发表时间：
2016-09-20
影响因子：
120.7
通讯作者：
Fauci, Anthony S.
中科院分区：
文献类型：
--
作者：
Marston, Hilary D.;Dixon, Dennis M.;Fauci, Anthony S.
抗生素的发展被认为是现代科学最重要的进步之一。抗生素挽救了数百万人的生命。然而，抗生素耐药性（antimicrobial resistance，AMR）威胁着这一进展，并对人类健康构成重大风险。目的：确定与AMR相关的因素，重要耐药微生物的流行病学现状，以及AMR问题的可能解决方案ClinicalTrials.gov。重点是流行病学，AMR的临床效果，发现治疗AMR细菌感染的新药物，以及消除或修饰AMR细菌的非药物策略。除了在这些数据库中发现的文章和条目外，还审查了选定的卫生政策报告和公共卫生指导文件。217篇文章，数据库和报告确定，103被选中进行review.RESULTS的增加AMR已被驱动的各种因素，包括不适当的抗生素处方和销售，使用抗生素以外的卫生保健部门，和遗传因素固有的细菌。由于对新抗菌剂的药物开发没有足够的经济激励，这一问题更加严重。一系列特定的AMR问题，包括碳青霉烯和粘菌素耐药革兰氏阴性菌，构成了临床挑战。解决AMR威胁的替代方法包括抗菌药物鉴定的新方法和中和毒力factors.Conclusions和相关性的策略抗菌药物耐药性对当前的临床护理提出了重大挑战。抗菌药物的改良使用和公共卫生干预措施，加上新的抗菌策略，可能有助于减轻未来多重耐药微生物的影响。
IMPORTANCE The development of antibiotics is considered among the most important advances of modern science. Antibiotics have saved millions of lives. However, antimicrobial resistance (AMR) threatens this progress and presents significant risks to human health.OBJECTIVE To identify factors associated with AMR, the current epidemiology of important resistant organisms, and possible solutions to the AMR problem.DATA SOURCES, STUDY SELECTION, AND DATA SYNTHESIS PubMed (2000-2016), NIH REPORTER, and ClinicalTrials.gov databases were searched for articles and entries related to AMR, focusing on epidemiology, clinical effects of AMR, discovery of novel agents to treat AMR bacterial infections, and nonpharmacological strategies to eliminate or modify AMR bacteria. In addition to articles and entries found in these databases, selected health policy reports and public health guidance documents were reviewed. Of 217 articles, databases, and reports identified, 103 were selected for review.RESULTS The increase in AMR has been driven by a diverse set of factors, including inappropriate antibiotic prescribing and sales, use of antibiotics outside of the health care sector, and genetic factors intrinsic to bacteria. The problem has been exacerbated by inadequate economic incentives for pharmaceutical development of new antimicrobial agents. A range of specific AMR concerns, including carbapenem-and colistin-resistant gram-negative organisms, pose a clinical challenge. Alternative approaches to address the AMR threat include new methods of antibacterial drug identification and strategies that neutralize virulence factors.CONCLUSIONS AND RELEVANCE Antimicrobial resistance poses significant challenges for current clinical care. Modified use of antimicrobial agents and public health interventions, coupled with novel antimicrobial strategies, may help mitigate the effect of multidrug-resistant organisms in the future.