Partnership for a cross-disciplinary approach to the ecology of antimicrobial drug resistance in Kenya

抗生素耐药性（ABR）是对未来有效医疗保健和兽医护理的重大威胁。在全球范围内，我们依赖抗生素来治疗常见和严重的感染，但我们滥用这些化合物的价值，不合理地使用它们。在肯尼亚，与许多其他国家一样，抗生素的处方是不必要的，也没有正确识别目标微生物，这一事实往往导致治疗失败。在农业中，抗生素通常由农民直接使用，因为它们在市场上很容易获得，无需处方。肯尼亚是一个正在经历人口向城市化过渡的国家，预计到本世纪中期，一半以上的人口将生活在城市地区。其中许多人可能生活在低收入住区（例如，首都内罗毕60%的居民生活在低收入住区=贫民窟）。这些场所缺乏高质量的保健服务。此外，随着越来越多的人生活在城镇，农民将面临更有效地生产更多粮食的压力，而其中的一个关键部分--就像更发达的经济体一样--将是使用抗生素药物。这些因素联合收割机产生了很大的风险，使高度耐药的微生物出现。预防这种情况的关键是在医院和农场收集高质量的数据，了解现在存在的抗性水平，以及生物体如何共享它们的基因，这一过程可能导致抗性性状的快速传播。其中一个关键方面是了解抗菌药物在实践中如何使用，如何采购以及是什么推动了个人和集体对抗菌药物使用的决策。我们的计划将调查这些不同的方面，并与肯尼亚和国际上制定政策的合作伙伴合作，以开发长期监测工具，计划限制耐药性的传播，并向公众提供保护这些重要药物的建议。

Antibacterial resistance (ABR) is a significant threat to the future of effective healthcare and veterinary care. Globally, we are dependent on antibiotics for treating common as well as severe infections, but we abuse the value of these compounds by using them irrationally. In Kenya, as in many other countries, antibiotics are prescribed un-necessarily and without properly identifying the micro-organims being targeted, a fact that often leads to treatment failures. In agriculture, antibiotics are often used directly by farmers, as they are readily available on the market without prescription. Kenya is a country undergoing a demographic transition towards urbanisation, with over half the population expected to be in urban zones by the middle of this century. Many of these people are likely to live in low income settlements (eg 60% of residents of Nairobi, the capital, live in low income settlements = slums). Provision of high quality heath care is lacking in such sites. Further, with more people living in towns and cities, the pressure will be on farmers to produce more food more efficiently, and a key part of this - as has been the case in more developed economies - will be to use antibiotic drugs. These factors combine to produce a great deal of risk for highly drug resistant micro-organisms to emerge. Essential in preventing this will be to collect high quality data in hospitals and on farms, to understand what levels of resistance are present now, and how the organisms share their genes, a process that can result in rapid spread of resistant traits. A key aspects of this is also to understand how antibacterial drugs are used in practice, how they are procured and what drives individual and collective decision making about their use. Our programme will investigate these different aspects and work with partners in Kenya and internationally who make policy, in order to develop long term surveillance tools, plans to limit the spread of resistance and advice to the public to conserve these important drugs.