Department of Veterinary Population Medicine, College of Veterinary Medicine, University of Minnesota, St. Paul, Minnesota 55108, USA; email:
Department of Veterinary and Biomedical Sciences, College of Veterinary Medicine, University of Minnesota, St. Paul, Minnesota 55108, USA; email:
Annu Rev Anim Biosci. 2021 Feb 16;9:313-332. doi: 10.1146/annurev-animal-072020-080638.
Antimicrobial resistance (AMR) is a threat to animal and human health. Antimicrobial use has been identified as a major driver of AMR, and reductions in use are a focal point of interventions to reduce resistance. Accordingly, stakeholders in human health and livestock production have implemented antimicrobial stewardship programs aimed at reducing use. Thus far, these efforts have yielded variable impacts on AMR. Furthermore, scientific advances are prompting an expansion and more nuanced appreciation of the many nonantibiotic factors that drive AMR, as well as how these factors vary across systems, geographies, and contexts. Given these trends, we propose a framework to prioritize AMR interventions. We use this framework to evaluate the impact of interventions that focus on antimicrobial use. We conclude by suggesting that priorities be expanded to include greater consideration of host-microbial interactions that dictate AMR, as well as anthropogenic and environmental systems that promote dissemination of AMR.
抗菌药物耐药性（AMR）对动物和人类健康构成威胁。抗菌药物的使用已被确定为 AMR 的主要驱动因素，减少使用是减少耐药性干预措施的重点。因此，人类健康和畜牧业利益相关者已经实施了抗菌药物管理计划，旨在减少使用。到目前为止，这些努力对抗菌药物耐药性的影响各不相同。此外，科学的进步促使人们更广泛地认识到推动抗菌药物耐药性的许多非抗生素因素，以及这些因素在不同系统、地理和背景下的差异。鉴于这些趋势，我们提出了一个框架来优先考虑抗菌药物耐药性干预措施。我们使用这个框架来评估侧重于抗菌药物使用的干预措施的影响。最后，我们建议扩大优先事项，以更充分地考虑决定抗菌药物耐药性的宿主-微生物相互作用，以及促进抗菌药物耐药性传播的人为和环境系统。
