Spread of resistant bacteria and resistance genes from animals to humans - The public health consequences
Spread of resistant bacteria and resistance genes from animals to humans - The public health consequences
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DOI：
10.1111/j.1439-0450.2004.00788.x
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发表时间：
2004-10-01
期刊：
影响因子：
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通讯作者：
Molbak, K
中科院分区：
文献类型：
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作者：
Molbak, K
本文回顾了食用动物使用抗菌药物与对人类致病的细菌出现抗菌药物耐药性之间的联系，特别关注公共卫生方面。食源性感染流行病学、生态学研究、疫情调查、分型研究和直接流行病学观察的推论表明，耐药菌是从食用动物转移到人类身上的。除了食物链中的转移之外，共生菌和病原菌之间移动遗传元件的交换也导致耐药性的出现。越来越多的证据表明，这对人类公共卫生产生了可衡量的影响。后果之一是人类不相关地使用抗微生物药物导致传播增加。其他后果与早期经验治疗的功效降低、确认微生物学诊断后治疗选择的限制以及最终可能的毒力特征的共同选择有关。最近的流行病学研究通过与耐药性相关的死亡率过高、病程延长以及感染耐药沙门氏菌后罹患侵袭性疾病或住院的风险增加来衡量这些后果。
The paper reviews the lines of evidence which link the use of antimicrobial drugs for food animals with the emergence of antimicrobial drug resistance in bacteria pathogenic to humans, with a particular focus on the public health aspects. Deductions from the epidemiology of food-borne infections, ecological studies, outbreak investigations, typing studies and direct epidemiological observations show that resistant bacteria are transferred from food animals to man. In addition to transfer in the food chain, exchange of mobile genetic elements among commensal and pathogenic bacteria contributes to the emergence of drug resistance. There is growing evidence that this has measurable consequences for human public health. One consequence is increased transmission supported by unrelated use of anti-microbials in humans. Other consequences are related to reduced efficacy of early empirical treatment, limitations in the choices for treatment after confirmed microbiological diagnosis, and finally a possible coselection of virulence traits. Recent epidemiological studies have measured these consequences in terms of excess mortality associated with resistance, increased duration of illness, and increased risk of invasive illness or hospitalization following infections with resistant Salmonella.