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低收入和中等收入国家现有干预措施可避免的细菌对抗菌药物耐药性负担:证据回顾和建模分析。

Burden of bacterial antimicrobial resistance in low-income and middle-income countries avertible by existing interventions: an evidence review and modelling analysis.

机构信息

Division of Epidemiology, School of Public Health, University of California, Berkeley, CA, USA.

Division of Infectious Diseases & HIV Medicine, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa.

出版信息

Lancet. 2024 Jun 1;403(10442):2439-2454. doi: 10.1016/S0140-6736(24)00862-6. Epub 2024 May 23.

Abstract

National action plans enumerate many interventions as potential strategies to reduce the burden of bacterial antimicrobial resistance (AMR). However, knowledge of the benefits achievable by specific approaches is needed to inform policy making, especially in low-income and middle-income countries (LMICs) with substantial AMR burden and low health-care system capacity. In a modelling analysis, we estimated that improving infection prevention and control programmes in LMIC health-care settings could prevent at least 337 000 (95% CI 250 200-465 200) AMR-associated deaths annually. Ensuring universal access to high-quality water, sanitation, and hygiene services would prevent 247 800 (160 000-337 800) AMR-associated deaths and paediatric vaccines 181 500 (153 400-206 800) AMR-associated deaths, from both direct prevention of resistant infections and reductions in antibiotic consumption. These estimates translate to prevention of 7·8% (5·6-11·0) of all AMR-associated mortality in LMICs by infection prevention and control, 5·7% (3·7-8·0) by water, sanitation, and hygiene, and 4·2% (3·4-5·1) by vaccination interventions. Despite the continuing need for research and innovation to overcome limitations of existing approaches, our findings indicate that reducing global AMR burden by 10% by the year 2030 is achievable with existing interventions. Our results should guide investments in public health interventions with the greatest potential to reduce AMR burden.

摘要

国家行动计划列举了许多干预措施,这些措施可能是减轻细菌对抗菌药物耐药性(AMR)负担的策略。然而,为了为决策提供信息,特别是在 AMR 负担重且医疗保健系统能力低的低收入和中等收入国家(LMICs),需要了解具体方法可实现的益处。在建模分析中,我们估计改善 LMIC 卫生保健环境中的感染预防和控制计划每年至少可以预防 337,000 例(95%CI250,200-465,200)与 AMR 相关的死亡。确保普遍获得高质量的水、卫生和个人卫生服务,将预防 247,800 例(160,000-337,800)与 AMR 相关的死亡,这既可以直接预防耐药感染,也可以减少抗生素的使用。这些估计表明,通过感染预防和控制措施可预防 LMICs 中所有与 AMR 相关死亡的 7.8%(5.6-11.0),通过水、卫生和个人卫生可预防 5.7%(3.7-8.0),通过疫苗接种干预措施可预防 4.2%(3.4-5.1)。尽管仍然需要研究和创新来克服现有方法的局限性,但我们的研究结果表明,通过现有干预措施,到 2030 年将全球 AMR 负担减少 10%是可行的。我们的研究结果应该指导投资于具有最大潜力减轻 AMR 负担的公共卫生干预措施。

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