Infectious Diseases Unit, Hospital Universitari Mútua de Terrassa, Barcelona.
Universitat Internacional de Catalunya.
Curr Opin Infect Dis. 2020 Dec;33(6):458-463. doi: 10.1097/QCO.0000000000000694.
The aim of this study was to describe the clinical and economic burden of bacterial antimicrobial resistance (AMR) and to provide an expert opinion on different approaches to fight it.
For several decades now, it has been known that AMR among human pathogens is related to high clinical and economic burden.Different strategies have been implemented to control the clinical and economic burden of AMR. Antimicrobial stewardship programmes (ASP), environmental cleaning and infection source control have been reported as the most effective interventions. There is a potential role for faecal microbiome transplant (FMT); however, long-term effectiveness and safety remain to be demonstrated. Another promising tool is to develop molecules to chelate or degrade residual antibiotics in the colon. Decolonization has demonstrated impact on methicillin-resistant Staphylococcus aureus (MRSA) infections, but there is limited evidence on the clinical impact and effectiveness of decolonization in MDR Gram-negative carriers.
A better assessment of AMR rates and the clinical and economic impact is needed. The epidemiology of AMR bacteria varies in different regions with MRSA, extended-spectrum beta-lactamase and carbapenamase-producing Enterobacterales being the most worrying. ASP and infection control have been increasingly demonstrated to impact on AMR rates. New approaches such as FMT and decolonization have still to demonstrate efficacy and safety.
本研究旨在描述细菌抗菌药物耐药性（AMR）的临床和经济负担，并就应对 AMR 的不同方法提供专家意见。
几十年来，人们已经认识到人类病原体中的 AMR 与高临床和经济负担有关。已经实施了不同的策略来控制 AMR 的临床和经济负担。抗菌药物管理计划（ASP）、环境清洁和感染源控制已被报道为最有效的干预措施。粪便微生物群移植（FMT）可能具有潜在作用；然而，其长期有效性和安全性仍有待证明。另一种有前途的工具是开发分子来螯合或降解结肠中残留的抗生素。去定植已被证明对耐甲氧西林金黄色葡萄球菌（MRSA）感染有影响，但关于 MDR 革兰氏阴性菌携带者去定植的临床影响和有效性的证据有限。
需要更好地评估 AMR 发生率以及临床和经济影响。AMR 细菌的流行病学在不同地区有所不同，其中 MRSA、产超广谱β-内酰胺酶和碳青霉烯酶的肠杆菌科最为令人担忧。ASP 和感染控制已被越来越多地证明可以影响 AMR 发生率。新方法，如 FMT 和去定植，仍需证明其疗效和安全性。
