Werner Guido, Abu Sin Muna, Bahrs Christina, Brogden Sandra, Feßler Andrea T, Hagel Stefan, Kaspar Heike, Köck Robin, Kreienbrock Lothar, Krüger-Haker Henrike, Maechler Frederike, Noll Ines, Pletz Mathias W, Tenhagen Bernd-Alois, Schwarz Stefan, Walther Birgit, Mielke Martin
Robert Koch Institut, Berlin, Deutschland.
Abt. Infektionskrankheiten, Fachgebiet Nosokomiale Infektionserreger und Antibiotikaresistenzen, Robert Koch-Institut, Außenstelle Wernigerode, Burgstr. 37, 38855, Wernigerode, Deutschland.
Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2023 Jun;66(6):628-643. doi: 10.1007/s00103-023-03713-4. Epub 2023 May 15.
One Health refers to a concept that links human, animal, and environmental health. In Germany, there is extensive data on antibiotic resistance (AMR) and multidrug-resistant (micro)organisms (MDRO) in human and veterinary medicine, as well as from studies in various environmental compartments (soil, water, wastewater). All these activities are conducted according to different specifications and standards, which makes it difficult to compare data. A focus on AMR and MDRO of human therapeutic importance is helpful to provide some guidance. Most data are available across sectors on methicillin-resistant Staphylococcus aureus (MRSA) and multiresistant Enterobacterales such as Escherichia coli and Klebsiella pneumoniae. Here, the trends of resistance are heterogeneous. Antibiotic use leads to MRE selection, which is well documented. Success in minimizing antibiotic use has also been demonstrated in recent years in several sectors and could be correlated with success in containing AMR and MDRO (e.g., decrease in MRSA in human medicine). Sector-specific measures to reduce the burden of MDRO and AMR are also necessary, as not all resistance problems are linked to other sectors. Carbapenem resistance is still rare, but most apparent in human pathogens. Colistin resistance occurs in different sectors but shows different mechanisms in each. Resistance to antibiotics of last resort such as linezolid is rare in Germany, but shows a specific One Health correlation. Efforts to harmonize methods, for example in the field of antimicrobial susceptibility testing and genome-based pathogen and AMR surveillance, are an important first step towards a better comparability of the different data collections.
“同一健康”指的是一个将人类、动物和环境卫生联系起来的概念。在德国，有关于人类和兽医学中抗生素耐药性（AMR）以及多重耐药（微）生物（MDRO）的大量数据，还有来自各个环境领域（土壤、水、废水）研究的数据。所有这些活动都是按照不同的规范和标准开展的，这使得数据难以比较。关注具有人类治疗重要性的AMR和MDRO有助于提供一些指导。跨部门可获取的大多数数据涉及耐甲氧西林金黄色葡萄球菌（MRSA）以及多重耐药肠杆菌科细菌，如大肠杆菌和肺炎克雷伯菌。在此，耐药趋势是多样的。抗生素的使用会导致耐多药肠杆菌的产生，这一点有充分记录。近年来，在几个领域也证明了在尽量减少抗生素使用方面取得的成功，并且这可能与控制AMR和MDRO的成功相关（例如，人类医学中MRSA的减少）。针对特定部门采取措施以减轻MDRO和AMR的负担也是必要的，因为并非所有耐药问题都与其他部门相关。碳青霉烯类耐药性仍然罕见，但在人类病原体中最为明显。黏菌素耐药性在不同部门都有发生，但在每个部门表现出不同的机制。在德国，对诸如利奈唑胺等最后手段抗生素的耐药性很少见，但呈现出特定的“同一健康”关联。努力统一方法，例如在抗菌药物敏感性测试以及基于基因组的病原体和AMR监测领域，是朝着更好地比较不同数据收集迈出的重要第一步。
