School of Life Sciences, University of Warwick, Coventry, UK.
Lancet Infect Dis. 2013 Feb;13(2):155-65. doi: 10.1016/S1473-3099(12)70317-1.
During the past 10 years, multidrug-resistant Gram-negative Enterobacteriaceae have become a substantial challenge to infection control. It has been suggested by clinicians that the effectiveness of antibiotics is in such rapid decline that, depending on the pathogen concerned, their future utility can be measured in decades or even years. Unless the rise in antibiotic resistance can be reversed, we can expect to see a substantial rise in incurable infection and fatality in both developed and developing regions. Antibiotic resistance develops through complex interactions, with resistance arising by de-novo mutation under clinical antibiotic selection or frequently by acquisition of mobile genes that have evolved over time in bacteria in the environment. The reservoir of resistance genes in the environment is due to a mix of naturally occurring resistance and those present in animal and human waste and the selective effects of pollutants, which can co-select for mobile genetic elements carrying multiple resistant genes. Less attention has been given to how anthropogenic activity might be causing evolution of antibiotic resistance in the environment. Although the economics of the pharmaceutical industry continue to restrict investment in novel biomedical responses, action must be taken to avoid the conjunction of factors that promote evolution and spread of antibiotic resistance.
在过去的 10 年中，多药耐药革兰氏阴性肠杆菌科已经成为感染控制的一个重大挑战。临床医生认为，抗生素的有效性正在迅速下降，根据具体病原体，其未来的应用可能只能持续几十年甚至几年。除非能够逆转抗生素耐药性的上升，否则我们可以预期，在发达和发展中地区，无法治愈的感染和死亡率都会大幅上升。抗生素耐药性是通过复杂的相互作用发展起来的，耐药性可以通过临床抗生素选择下的新突变产生，也可以通过环境中细菌中随时间进化的移动基因的频繁获得产生。环境中耐药基因的储库是由于自然存在的耐药性和存在于动物和人类废物中的耐药性以及污染物的选择作用共同导致的，这些选择作用可以共同选择携带多种耐药基因的移动遗传元件。人们对人为活动如何可能导致环境中抗生素耐药性的进化关注较少。尽管制药行业的经济学继续限制对新型生物医学反应的投资，但必须采取行动，避免促进抗生素耐药性进化和传播的因素结合在一起。
