Understanding the mechanisms and drivers of antimicrobial resistance

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• 作者：Prof Alison H Holmes ; MD^a ; ^{alison.holmes@imperial.ac.uk" class="auth_mail" title="E-mail the corresponding author} ; Luke S P Moore ; MPH^a ; Arnfinn Sundsfjord ; MD^b ; ^c ; Martin Steinbakk ; MD^d ; Sadie Regmi ; MBChB^e ; Abhilasha Karkey ; DPhil^f ; Philippe J Guerin ; MD^g ; Laura J V Piddock ; PhD^h
• 刊名：The Lancet
• 出版年：2016
• 出版时间：9-15 January 2016
• 年：2016
• 卷：387
• 期：10014
• 页码：176-187
• 全文大小：992 K

文摘

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 affected 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 fitness cost, an effect 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 five 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 effective antimicrobials.