McDermott P F, Zhao S, Wagner D D, Simjee S, Walker R D, White D G
Office of Research, Center for Veterinary Medicine, U.S. Food and Drug Administration, Laurel, MD 20708, USA.
Anim Biotechnol. 2002 May;13(1):71-84. doi: 10.1081/ABIO-120005771.
Bacterial antimicrobial resistance in both the medical and agricultural fields has become a serious problem worldwide. Antibiotic resistant strains of bacteria are an increasing threat to animal and human health, with resistance mechanisms having been identified and described for all known antimicrobials currently available for clinical use. There is currently increased public and scientific interest regarding the administration of therapeutic and sub-therapeutic antimicrobials to animals, due primarily to the emergence and dissemination of multiple antibiotic resistant zoonotic bacterial pathogens. This issue has been the subject of heated debates for many years, however, there is still no complete consensus on the significance of antimicrobial use in animals, or resistance in bacterial isolates from animals, on the development and dissemination of antibiotic resistance among human bacterial pathogens. In fact, the debate regarding antimicrobial use in animals and subsequent human health implications has been going on for over 30 years, beginning with the release of the Swann report in the United Kingdom. The latest report released by the National Research Council (1998) confirmed that there were substantial information gaps that contribute to the difficulty of assessing potential detrimental effects of antimicrobials in food animals on human health. Regardless of the controversy, bacterial pathogens of animal and human origin are becoming increasingly resistant to most frontline antimicrobials, including expanded-spectrum cephalosporins, aminoglycosides, and even fluoroquinolones. The lion's share of these antimicrobial resistant phenotypes is gained from extra-chromosomal genes that may impart resistance to an entire antimicrobial class. In recent years, a number of these resistance genes have been associated with large, transferable, extra-chromosomal DNA elements, called plasmids, on which may be other DNA mobile elements, such as transposons and integrons. These DNA mobile elements have been shown to transmit genetic determinants for several different antimicrobial resistance mechanisms and may account for the rapid dissemination of resistance genes among different bacteria. The increasing incidence of antimicrobial resistant bacterial pathogens has severe implications for the future treatment and prevention of infectious diseases in both animals and humans. Although much scientific information is available on this subject, many aspects of the development of antimicrobial resistance still remain uncertain. The emergence and dissemination of bacterial antimicrobial resistance is the result of numerous complex interactions among antimicrobials, microorganisms, and the surrounding environments. Although research has linked the use of antibiotics in agriculture to the emergence of antibiotic-resistant foodborne pathogens, debate still continues whether this role is significant enough to merit further regulation or restriction.
医学和农业领域的细菌抗药性已成为全球范围内的一个严重问题。抗生素耐药性细菌菌株对动物和人类健康构成的威胁日益增加，目前已针对所有临床可用的已知抗菌药物确定并描述了耐药机制。当前，公众和科学界对给动物使用治疗性和亚治疗性抗菌药物的关注度有所提高，这主要是由于多种抗生素耐药性人畜共患病细菌病原体的出现和传播所致。多年来，这个问题一直是激烈辩论的主题，然而，对于动物使用抗菌药物的意义、动物细菌分离株中的耐药性以及人类细菌病原体中抗生素耐药性的发展和传播，仍未达成完全共识。事实上，关于动物使用抗菌药物及其对人类健康的后续影响的辩论已经持续了30多年，始于英国发布的斯旺报告。美国国家研究委员会（1998年）发布的最新报告证实，存在大量信息空白，这导致难以评估食用动物中抗菌药物对人类健康的潜在有害影响。尽管存在争议，但动物源和人类源的细菌病原体对大多数一线抗菌药物的耐药性正日益增强，包括广谱头孢菌素、氨基糖苷类药物，甚至氟喹诺酮类药物。这些抗菌药物耐药表型的很大一部分来自于染色体外基因，这些基因可能赋予对整个抗菌药物类别的耐药性。近年来，许多此类耐药基因与大型、可转移的染色体外DNA元件（称为质粒）相关联，质粒上可能还有其他DNA移动元件，如转座子和整合子。这些DNA移动元件已被证明可传播几种不同抗菌药物耐药机制的遗传决定因素，并可能导致耐药基因在不同细菌之间迅速传播。抗菌药物耐药性细菌病原体发病率的上升对未来动物和人类传染病治疗与预防具有严重影响。尽管关于这个主题有很多科学信息，但抗菌药物耐药性发展的许多方面仍不确定。细菌抗药性的出现和传播是抗菌药物、微生物及周围环境之间众多复杂相互作用的结果。尽管研究已将农业中抗生素的使用与抗生素耐药性食源性病原体的出现联系起来，但关于这一作用是否足够显著，值得进一步监管或限制的争论仍在继续。
