Collignon Peter J, McEwen Scott A
Infectious Diseases and Microbiology, Canberra Hospital, Garran, ACT 2605, Australia.
Medical School, Australian National University, Acton ACT 2601, Australia.
Trop Med Infect Dis. 2019 Jan 29;4(1):22. doi: 10.3390/tropicalmed4010022.
Approaching any issue from a One Health perspective necessitates looking at the interactions of people, domestic animals, wildlife, plants, and our environment. For antimicrobial resistance this includes antimicrobial use (and abuse) in the human, animal and environmental sectors. More importantly, the spread of resistant bacteria and resistance determinants within and between these sectors and globally must be addressed. Better managing this problem includes taking steps to preserve the continued effectiveness of existing antimicrobials such as trying to eliminate their inappropriate use, particularly where they are used in high volumes. Examples are the mass medication of animals with critically important antimicrobials for humans, such as third generation cephalosporins and fluoroquinolones, and the long term, in-feed use of antimicrobials, such colistin, tetracyclines and macrolides, for growth promotion. In people it is essential to better prevent infections, reduce over-prescribing and over-use of antimicrobials and stop resistant bacteria from spreading by improving hygiene and infection control, drinking water and sanitation. Pollution from inadequate treatment of industrial, residential and farm waste is expanding the resistome in the environment. Numerous countries and several international agencies have now included a One Health Approach within their action plans to address antimicrobial resistance. Necessary actions include improvements in antimicrobial use, better regulation and policy, as well as improved surveillance, stewardship, infection control, sanitation, animal husbandry, and finding alternatives to antimicrobials.
从“同一健康”的视角处理任何问题都需要审视人类、家畜、野生动物、植物以及我们的环境之间的相互作用。对于抗菌药物耐药性而言，这包括人类、动物和环境领域对抗菌药物的使用（以及滥用）。更重要的是，必须解决耐药细菌和耐药决定因素在这些领域内部、之间以及全球范围内的传播问题。更好地管理这一问题包括采取措施来维持现有抗菌药物的持续有效性，比如设法消除其不当使用，尤其是在大量使用的情况下。例如，对动物大量使用对人类至关重要的抗菌药物，如第三代头孢菌素和氟喹诺酮类，以及长期在饲料中添加黏菌素、四环素和大环内酯类等抗菌药物以促进生长。对人类来说，必须更好地预防感染，减少抗菌药物的过度处方和过度使用，并通过改善卫生和感染控制、饮用水及环境卫生来阻止耐药细菌的传播。工业、住宅和农场废物处理不当造成的污染正在扩大环境中的耐药基因库。现在，许多国家和一些国际机构已将“同一健康”方法纳入其应对抗菌药物耐药性的行动计划中。必要的行动包括改进抗菌药物的使用、加强监管和政策制定，以及改善监测、管理、感染控制、环境卫生、畜牧业，并寻找抗菌药物的替代品。
