David Price Evans Infectious Diseases & Global Health Group, University of Liverpool, Liverpool, UK.
Malawi-Liverpool-Wellcome Research Programme, Blantyre, Malawi.
Nat Rev Microbiol. 2024 Oct;22(10):636-649. doi: 10.1038/s41579-024-01076-4. Epub 2024 Jul 24.
Antimicrobial resistance (AMR) is a global health challenge that threatens humans, animals and the environment. Evidence is emerging for a role of healthcare infrastructure, environments and patient pathways in promoting and maintaining AMR via direct and indirect mechanisms. Advances in vaccination and monoclonal antibody therapies together with integrated surveillance, rapid diagnostics, targeted antimicrobial therapy and infection control measures offer opportunities to address healthcare-associated AMR risks more effectively. Additionally, innovations in artificial intelligence, data linkage and intelligent systems can be used to better predict and reduce AMR and improve healthcare resilience. In this Review, we examine the mechanisms by which healthcare functions as a driver, reservoir and amplifier of AMR, contextualized within a One Health framework. We also explore the opportunities and innovative solutions that can be used to combat AMR throughout the patient journey. We provide a perspective on the current evidence for the effectiveness of interventions designed to mitigate healthcare-associated AMR and promote healthcare resilience within high-income and resource-limited settings, as well as the challenges associated with their implementation.
抗菌药物耐药性（AMR）是一个全球性的健康挑战，威胁着人类、动物和环境。越来越多的证据表明，医疗保健基础设施、环境和患者途径通过直接和间接机制在促进和维持 AMR 方面发挥作用。疫苗接种和单克隆抗体治疗的进步，以及综合监测、快速诊断、靶向抗菌治疗和感染控制措施，为更有效地解决与医疗保健相关的 AMR 风险提供了机会。此外，人工智能、数据链接和智能系统的创新可以用于更好地预测和减少 AMR 并提高医疗保健的弹性。在这篇综述中，我们在一个“同一健康”框架内，考察了医疗保健作为 AMR 的驱动因素、储存库和放大器的作用机制。我们还探讨了可以在整个患者治疗过程中用于对抗 AMR 的机会和创新解决方案。我们提供了一个视角，来看设计用于减轻与医疗保健相关的 AMR 并促进高收入和资源有限环境中的医疗保健弹性的干预措施的有效性，以及与实施相关的挑战。
