Salam Md Abdus, Al-Amin Md Yusuf, Salam Moushumi Tabassoom, Pawar Jogendra Singh, Akhter Naseem, Rabaan Ali A, Alqumber Mohammed A A
Department of Basic Medical Sciences, Kulliyyah of Medicine, International Islamic University Malaysia, Kuantan 25200, Malaysia.
Purdue University Interdisciplinary Life Sciences Graduate Program, Purdue University, West Lafayette, IN 47907, USA.
Healthcare (Basel). 2023 Jul 5;11(13):1946. doi: 10.3390/healthcare11131946.
Antibiotics are among the most important discoveries of the 20th century, having saved millions of lives from infectious diseases. Microbes have developed acquired antimicrobial resistance (AMR) to many drugs due to high selection pressure from increasing use and misuse of antibiotics over the years. The transmission and acquisition of AMR occur primarily via a human-human interface both within and outside of healthcare facilities. A huge number of interdependent factors related to healthcare and agriculture govern the development of AMR through various drug-resistance mechanisms. The emergence and spread of AMR from the unrestricted use of antimicrobials in livestock feed has been a major contributing factor. The prevalence of antimicrobial-resistant bacteria has attained an incongruous level worldwide and threatens global public health as a silent pandemic, necessitating urgent intervention. Therapeutic options of infections caused by antimicrobial-resistant bacteria are limited, resulting in significant morbidity and mortality with high financial impact. The paucity in discovery and supply of new novel antimicrobials to treat life-threatening infections by resistant pathogens stands in sharp contrast to demand. Immediate interventions to contain AMR include surveillance and monitoring, minimizing over-the-counter antibiotics and antibiotics in food animals, access to quality and affordable medicines, vaccines and diagnostics, and enforcement of legislation. An orchestrated collaborative action within and between multiple national and international organizations is required urgently, otherwise, a postantibiotic era can be a more real possibility than an apocalyptic fantasy for the 21st century. This narrative review highlights on this basis, mechanisms and factors in microbial resistance, and key strategies to combat antimicrobial resistance.
抗生素是20世纪最重要的发现之一，已从传染病中拯救了数百万人的生命。由于多年来抗生素使用和滥用导致的高选择压力，微生物已对许多药物产生了获得性抗菌耐药性（AMR）。AMR的传播和获得主要通过医疗机构内外的人际界面发生。大量与医疗保健和农业相关的相互依存因素通过各种耐药机制控制着AMR的发展。在牲畜饲料中无限制使用抗菌药物导致的AMR出现和传播是一个主要促成因素。抗菌耐药细菌的流行在全球范围内已达到不协调的水平，并作为一种无声的大流行威胁着全球公共卫生，因此需要紧急干预。由抗菌耐药细菌引起的感染的治疗选择有限，导致了高发病率和死亡率，并产生了巨大的经济影响。用于治疗由耐药病原体引起的危及生命的感染的新型抗菌药物在发现和供应方面的匮乏与需求形成了鲜明对比。遏制AMR的立即干预措施包括监测和监督、尽量减少非处方抗生素和食用动物中的抗生素、提供质量可靠且价格合理的药品、疫苗和诊断方法以及执行立法。迫切需要多个国家和国际组织内部及之间精心策划的合作行动，否则，后抗生素时代对21世纪来说可能比世界末日的幻想更有可能成为现实。在此基础上，本叙述性综述重点介绍了微生物耐药性的机制和因素，以及对抗抗菌耐药性的关键策略。
