Mølbak K
Department of Epidemiology, Statens Serum Institut, Copenhagen, Denmark.
J Vet Med B Infect Dis Vet Public Health. 2004 Oct-Nov;51(8-9):364-9. doi: 10.1111/j.1439-0450.2004.00788.x.
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.
本文综述了将用于食用动物的抗菌药物与对人类致病细菌中抗菌药物耐药性的出现联系起来的证据线索，特别关注公共卫生方面。从食源性感染的流行病学、生态学研究、疫情调查、分型研究和直接流行病学观察得出的推论表明，耐药细菌从食用动物转移到人类。除了在食物链中的转移外，共生菌和病原菌之间移动遗传元件的交换也促成了耐药性的出现。越来越多的证据表明，这对人类公共卫生有可衡量的影响。一个后果是人类不相关使用抗菌药物导致传播增加。其他后果与早期经验性治疗疗效降低、微生物学确诊后治疗选择受限以及最终可能共同选择毒力性状有关。最近的流行病学研究已根据与耐药性相关的额外死亡率、疾病持续时间增加以及感染耐药沙门氏菌后侵袭性疾病或住院风险增加来衡量这些后果。
