Strategies to reduce the burden of antibiotic resistance in China

抗菌素耐药性(AMR)，尤其是抗生素耐药性(ABR)已成为全球最复杂的公共卫生挑战之一。据估计，到2050年，AMR将导致1000万人死亡，其中473万人在亚洲，国内生产总值(GDP)相应减少2%至3.5%，这将使世界损失高达100万亿美元。我们的合作研究和培训计划将汇集中国和英国顶尖大学的国际专家，以解决抗生素耐药性问题，这是一种对人类健康最紧迫的耐药。据估计，中国是世界上第二大抗生素消费国，在人类和牲畜中广泛使用抗生素，而且往往是非必要的。广泛的消费导致水和土壤中的抗生素残留，这可能会加剧耐药性的发展和通过环境中的有机体和化学物质传播。已有研究对中国耐药感染的流行病学和耐药模式进行了调查，但在全国范围内ABR造成的健康和经济负担的大小以及环境在耐药发展和传播中的作用仍不清楚。中国的大多数ABR研究都集中在医院患者、选定的食用动物或分离的决定因素中的特定细菌。迫切需要更好的证据和更广泛的了解，从系统的角度认识到这些领域之间的相互作用，从而更好地了解ABR的环境、社区、经济和医疗保健驱动因素和负担，以及衡量不同ABR减少干预策略的有效性的评估工具。由于人口密集，畜牧业集约化，抗生素使用量大，中国东部是控制抗生素使用和ABR的重点地区。我们的研究旨在通过一系列紧密联系的项目来弥合这些关键证据差距，并加强学科和方法研究技能，这些项目将产生设计、交付和监测有针对性的战略所需的整体知识，以在中国和类似环境中限制ABR。我们还将与中国目前缺乏的跨学科研究专业知识建立可持续的伙伴关系，并加强政策相关研究的能力。由于抗生素耐药感染及其遗传成分通过国际旅行迅速传播，研究减轻中国抗生素耐药负担的方法不仅对中国和更广泛的亚洲地区的人群，而且对全球都很重要。通过在中国的三所顶尖大学开展的三个相互关联的工作计划，在来自多个学科的英国学者的支持下，我们将：1.估计AMR的经济负担，并确定潜在干预策略的成本效益2.设计和评估一项量身定制的干预措施，以改变卫生专业人员的抗生素处方行为，减少门诊患者的抗生素消耗3.测量人类从环境和牲畜来源获得的抗生素暴露。评估其对健康的影响，开发风险评估和监测环境中暴露于抗生素和抗生素耐药基因的工具4。收集关于当前抗生素使用模式以及地方、地区和国家各级ABR相关政策和法规执行情况的证据5.就优化抗生素使用、监测ABR和评估CHINA6减少ABR战略的成功情况提出循证建议。建立跨机构和国际合作小组，以提高中国在一系列相关学科和方法方面的研究能力，以及在设计和实施跨学科研究方面的能力。

Antimicrobial resistance (AMR) and particularly resistance to antibiotics (ABR) has become one of the most complex public health challenges globally. Estimates have suggested that by 2050 AMR will be responsible for 10 million deaths, of which 4.73 million are in Asia, with an associated reduction of 2% to 3.5% in Gross Domestic Product (GDP) that will cost the world up to 100 trillion USD. Our collaborative research and training programme will bring together international experts at leading universities in China and the UK to tackle antibiotic resistance, the type of AMR that is the most pressing concern for human health. China is estimated to be the second largest consumer of antibiotics in the world, with widespread and often inessential use in both humans and livestock. Widespread consumption leads to antibiotic residues in water and soil that may exacerbate the development and transmission of resistance through organisms and chemicals in the environment. Studies have investigated the epidemiology and pattern of drug-resistant infections in China, but the size of the health and economic burdens caused by ABR on a national level and the role of the environment in the development and transmission of drug resistance are still unclear. Most ABR research in China has focused on specific bacteria in hospital patients, selected food animals, or isolated determinants. Better evidence and broader understanding of environmental, community, economic and health care drivers and burdens of ABR based on a systems perspective that recognises interactions between these areas is urgently needed, as are evaluation tools to measure the effectiveness of different ABR-reducing intervention strategies. Due to a dense population, an intensive livestock breeding industry and massive antibiotic use, Eastern China is a key region for controlling antibiotic use and ABR. Our research aims to bridge these key evidence gaps and strengthen disciplinary and methodological research skills, through a set of closely linked projects that will generate the holistic knowledge which is needed to design, deliver and monitor targeted strategies to limit ABR in China and comparable settings. We will also establish sustainable partnerships with cross-disciplinary research expertise that is currently lacking in China and strengthen capacity in policy-relevant research. Since antibiotic resistant infections and their genetic components spread rapidly through international travel, research into ways of reducing the burden of ABR in China is important not only for populations in China and the wider Asian region, but globally.Through three linked programmes of work based at three leading universities in China, supported by UK academics from a wide range of disciplines, we will:1. Estimate the economic burden of AMR and determine the cost-effectiveness of potential intervention strategies 2. Design and evaluate a tailored intervention to modify antibiotic prescribing behaviour among health professionals and reduce antibiotic consumption among outpatients 3. Measure human exposure to antibiotics from environmental and livestock sources, estimate their health effects & develop tools for risk assessment and monitoring of environmental exposures to antibiotics and antibiotic-resistant genes4. Gather evidence on current patterns of antibiotic use and the implementation of ABR-related policies and regulations at local, regional and national levels 5. Produce evidence-based recommendations on optimising antibiotic use, monitoring ABR and assessing the success of strategies to reduce ABR in China6. Build cross-institutional and international collaborative groups to increase China's research capacity in a range of relevant disciplines and methodologies, as well as in the design and conduct of inter-disciplinary research.