School of Biosciences, University of Nottingham, Sutton Bonington Campus, Loughborough, Nottingham, United Kingdom.
Department of Mathematics and Applied Mathematics, University of Johannesburg, Rossmore, South Africa.
PLoS One. 2023 Aug 17;18(8):e0289941. doi: 10.1371/journal.pone.0289941. eCollection 2023.
Antimicrobial resistant bacterial infections represent one of the most serious contemporary global healthcare crises. Acquisition and spread of resistant infections can occur through community, hospitals, food, water or endogenous bacteria. Global efforts to reduce resistance have typically focussed on antibiotic use, hygiene and sanitation and drug discovery. However, resistance in endogenous infections, e.g. many urinary tract infections, can result from life-long acquisition and persistence of resistance genes in commensal microbial flora of individual patients, which is not normally considered. Here, using individual based Monte Carlo models calibrated using antibiotic use data and human gut resistomes, we show that the long-term increase in resistance in human gut microbiomes can be substantially lowered by reducing exposure to resistance genes found food and water, alongside reduced medical antibiotic use. Reduced dietary exposure is especially important during patient antibiotic treatment because of increased selection for resistance gene retention; inappropriate use of antibiotics can be directly harmful to the patient being treated for the same reason. We conclude that a holistic approach to antimicrobial resistance that additionally incorporates food production and dietary considerations will be more effective in reducing resistant infections than a purely medical-based approach.
抗微生物耐药细菌感染是当代全球最严重的卫生保健危机之一。耐药感染的获得和传播可通过社区、医院、食物、水或内源性细菌进行。全球减少耐药的努力通常集中在抗生素使用、卫生和环境卫生以及药物发现上。然而，内源性感染（例如许多尿路感染）的耐药性可能是由于个体患者共生微生物群落中耐药基因的终身获得和持续存在所致，而这通常未被考虑在内。在这里，我们使用基于个体的蒙特卡罗模型，通过使用抗生素使用数据和人类肠道耐药组进行校准，表明通过减少食物和水中发现的耐药基因的暴露，同时减少医学抗生素的使用，可以大大降低人类肠道微生物组中耐药性的长期增加。在患者接受抗生素治疗期间，减少饮食暴露尤为重要，因为这会增加对耐药基因保留的选择；由于同样的原因，抗生素的不当使用可能会直接对接受治疗的患者造成伤害。我们的结论是，将食物生产和饮食因素纳入其中的抗微生物耐药性综合方法将比单纯基于医学的方法更有效地减少耐药感染。
