摘要

微生物药物耐药性（AMR）使全球人群传染病发病率不断上升，对于这种疾病无法用任何已知的抗菌药物治愈。这场危机将对人类造成毁灭性的损失，因为衰弱性和致命性疾病的频率和范围都在增加。产生这一危机三个主要原因：（1）在微生物中AMR表型频率增加是广泛使用抗菌药物的进化反应; （2）人口众多，全球联系密切的地区使任何环境中的病原体都能进入人体; （3）人类大范围滥用抗菌剂，为微生物的耐药性进化提供了强大的选择压力。在这些因素中，人口规模最不受快速变化影响。相反，其余两个因素可能会受到影响，因此提出一种应对危机的手段：通过减少抗生素使用，可以减缓AMR以及微生物世界中毒力因子的进化速度。这可以从根本上减少目前和未来抗菌素的全球使用来实现。目前的管理措施对抗菌剂使用制定法律，并在这些问题上教育医疗保健界，虽然有用，但并没有全面解决减少抗菌素使用的问题。我们建议，除了目前的措施和对更多新型抗菌药物和诊断试剂的研究之外，还需要全面的教育计划，将抗菌药物使用的从一线治疗转变为治疗失败后最后一种方案。

The antimicrobial resistance (AMR) crisis is the increasing global incidence of infectious diseases affecting the human population, which are untreatable with any known antimicrobial agent. This crisis will have a devastating cost on human society as both debilitating and lethal diseases increase in frequency and scope. Three major factors determine this crisis: (1) the increasing frequency of AMR phenotypes among microbes is an evolutionary response to the widespread use of antimicrobials; (2) the large and globally connected human population allows pathogens in any environment access to all of humanity; and (3) the extensive and often unnecessary use of antimicrobials by humanity provides the strong selective pressure that is driving the evolutionary response in the microbial world. Of these factors, the size of the human population is least amenable to rapid change. In contrast, the remaining two factors may be affected, so offering a means of managing the crisis: the rate at which AMR, as well as virulence factors evolve in microbial world may be slowed by reducing the applied selective pressure. This may be accomplished by radically reducing the global use of current and prospective antimicrobials. Current management measures to legislate the use of antimicrobials and to educate the healthcare world in the issues, while useful, have not comprehensively addressed the problem of achieving an overall reduction in the human use of antimicrobials. We propose that in addition to current measures and increased research into new antimicrobials and diagnostics, a comprehensive education program will be required to change the public paradigm of antimicrobial usage from that of a first line treatment to that of a last resort when all other therapeutic options have failed.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4165128/