Phillips Ian
Int J Antimicrob Agents. 2007 Aug;30(2):101-7. doi: 10.1016/j.ijantimicag.2007.02.018. Epub 2007 Apr 30.
The glycopeptide avoparcin, bacitracin, the macrolides spiramycin and tylosin, and the streptogramin virginiamycin were withdrawn as growth promoters in the European Union between 1995 and 1999 on the basis of the Precautionary Principle. Relevant resistance thereupon diminished among enterococci (the indicator organisms) isolated from animal and human faeces. However, animal enterococci were shown to differ from those that caused human infections, although their resistance genes were sometimes indistinguishable and thus probably have a common origin. Before the ban, human clinical isolates of enterococci resistant to vancomycin or teicoplanin were uncommon in many, but not all, parts of Europe and resistance to quinupristin/dalfopristin in the case of Enterococcus faecium was very rare. After the ban, these resistances increased in prevalence almost universally, to the detriment of human health. Campylobacters, normally susceptible to macrolides, increased in prevalence before and after the ban. Analyses suggest that the added risk to human health from resistance among enterococci and campylobacters selected by growth promoter use is small, whilst the benefit to human health from their use, hitherto largely ignored, might more than counterbalance this.
基于预防原则，糖肽类的阿伏霉素、杆菌肽、大环内酯类的螺旋霉素和泰乐菌素以及链阳性菌素类的维吉尼亚霉素于1995年至1999年间在欧盟被撤销作为生长促进剂使用。此后，从动物和人类粪便中分离出的肠球菌（指示生物）的相关耐药性有所下降。然而，动物肠球菌与引起人类感染的肠球菌有所不同，尽管它们的耐药基因有时难以区分，因此可能有共同的起源。在禁令实施前，耐万古霉素或替考拉宁的肠球菌的人类临床分离株在欧洲许多（但不是所有）地区并不常见，而粪肠球菌对奎奴普丁/达福普汀的耐药性非常罕见。禁令实施后，这些耐药性几乎普遍增加，对人类健康造成损害。弯曲杆菌通常对大环内酯类敏感，在禁令前后其流行率都有所上升。分析表明，生长促进剂使用所选择的肠球菌和弯曲杆菌耐药性给人类健康带来的额外风险很小，而它们的使用对人类健康的益处（迄今在很大程度上被忽视）可能会超过这一风险。
