Am J Vet Res. 2024 Mar 9;85(4). doi: 10.2460/ajvr.24.01.0014. Print 2024 Apr 1.
Since their commercialization, scientists have known that antimicrobial use kills or inhibits susceptible bacteria while allowing resistant bacteria to survive and expand. Today there is widespread antimicrobial resistance (AMR), even to antimicrobials of last resort such as the carbapenems, which are reserved for use in life-threatening infections. It is often convenient to assign responsibility for this global health crisis to the users and prescribers of antimicrobials. However, we know that animals never treated with antimicrobials carry clinically relevant AMR bacteria and genes. The causal pathway from bacterial susceptibility to resistance is not simple, and dissemination is cyclical rather than linear. Amplification of AMR occurs in healthcare environments and on farms where frequent exposure to antimicrobials selects for resistant bacterial populations. The recipients of antimicrobial therapy release antimicrobial residues, resistant bacteria, and resistance genes in waste products. These are reduced but not removed during wastewater and manure treatment and enter surface waters, soils, recreational parks, wildlife, and fields where animals graze and crops are grown for human and animal consumption. The cycle is complete when a patient carrying AMR bacteria is treated with antimicrobials that amplify the resistant bacterial populations. Reducing the development and spread of AMR requires a One Health approach with the combined commitment of governments, medical and veterinary professionals, agricultural industries, food and feed processors, and environmental scientists. In this review and in the companion Currents in One Health by Ballash et al, JAVMA, April 2024, we highlight just a few of the steps of the complex cyclical causal pathway that leads to the amplification, dissemination, and maintenance of AMR.
自商业化以来，科学家们已经知道，抗菌药物的使用会杀死或抑制敏感细菌，而使耐药细菌得以存活和繁殖。如今，广泛存在着抗菌药物耐药性（AMR），甚至对碳青霉烯类等最后手段的抗菌药物也存在耐药性，而碳青霉烯类药物是保留用于危及生命的感染的。人们通常将这种全球健康危机归咎于抗菌药物的使用者和开具者。然而，我们知道，从未使用过抗菌药物的动物携带具有临床相关性的 AMR 细菌和基因。从细菌敏感性到耐药性的因果关系并非简单，传播是循环的而不是线性的。AMR 的扩增发生在医疗机构和农场中，这些地方频繁接触抗菌药物会选择耐药细菌种群。接受抗菌药物治疗的患者会在废物中释放抗菌药物残留、耐药细菌和耐药基因。这些在废水和粪便处理过程中会减少，但不会被去除，然后进入地表水、土壤、娱乐公园、野生动物和动物放牧以及种植人类和动物食用作物的农田。当携带 AMR 细菌的患者接受会放大耐药细菌种群的抗菌药物治疗时，循环就完成了。减少 AMR 的发展和传播需要采取一种“同一健康”方法，需要政府、医疗和兽医专业人员、农业产业、食品和饲料加工商以及环境科学家共同承诺。在这篇评论文章和 JAVMA 即将发表的 Ballash 等人的同期 Currents in One Health 中，我们仅强调了导致 AMR 放大、传播和维持的复杂循环因果关系路径的几个步骤。
