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多重耐药菌的全球负担

The Global Burden of Multidrug-Resistant Bacteria.

作者信息

Marino Andrea, Maniaci Antonino, Lentini Mario, Ronsivalle Salvatore, Nunnari Giuseppe, Cocuzza Salvatore, Parisi Federica Maria, Cacopardo Bruno, Lavalle Salvatore, La Via Luigi

机构信息

Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, ARNAS Garibaldi Hospital, University of Catania, 95123 Catania, Italy.

Department of Medicine and Surgery, University of Enna "Kore", 94100 Enna, Italy.

出版信息

Epidemiologia (Basel). 2025 May 5;6(2):21. doi: 10.3390/epidemiologia6020021.

Abstract

This narrative review provided a broad synthesis of recent epidemiological trends, priority resistance mechanisms, and public health implications of multidrug-resistant (MDR) bacteria. We focused on the most clinically significant MDR pathogens, regional differences in resistance, and the effectiveness of containment strategies. Our goal was to synthesize current knowledge and propose research directions. Through comprehensive analysis of epidemiological studies, surveillance reports, clinical trials, and meta-analyses, we present a detailed assessment of the evolving landscape of antimicrobial resistance across both developed and developing nations. The review encompasses data from 187 countries, analyzing over 2500 published studies and reports from major health organizations. Our findings reveal a concerning 43% increase in multidrug-resistant infections globally, with particularly sharp rises in healthcare-associated infections (67% increase) and community-acquired infections (38% increase) in regions with high antibiotic misuse. The analysis specifically focuses on critical pathogens, including methicillin-resistant (MRSA), extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL), and carbapenem-resistant Enterobacteriaceae (CRE), documenting their prevalence, transmission patterns, and treatment outcomes. Economic impact assessments indicate annual global healthcare costs exceeding USD 100 billion due to resistant infections. The review identifies significant gaps in current surveillance systems, particularly in low- and middle-income countries, and proposes standardized approaches for monitoring and containment strategies. We evaluate the effectiveness of various antimicrobial stewardship programs, documenting success rates and implementation challenges across different healthcare settings. The analysis concludes with evidence-based recommendations for policy reforms, research priorities, and international collaboration frameworks necessary to address this growing global health crisis. Our findings highlighted the importance of strengthening stewardship efforts, proposing novel diagnostics and therapeutic interventions, and addressing inequities in access to care and data across different countries.

摘要

本叙述性综述广泛综合了近期多重耐药(MDR)细菌的流行病学趋势、主要耐药机制及对公共卫生的影响。我们重点关注了临床上最重要的MDR病原体、耐药性的区域差异以及控制策略的有效性。我们的目标是综合当前知识并提出研究方向。通过对流行病学研究、监测报告、临床试验和荟萃分析的全面分析,我们对发达国家和发展中国家抗菌药物耐药性的不断变化态势进行了详细评估。该综述涵盖了来自187个国家的数据,分析了来自主要卫生组织的2500多篇已发表的研究和报告。我们的研究结果显示,全球多重耐药感染令人担忧地增加了43%,在抗生素滥用严重的地区,医疗保健相关感染(增加67%)和社区获得性感染(增加38%)的增幅尤为显著。分析特别关注了关键病原体,包括耐甲氧西林金黄色葡萄球菌(MRSA)、产超广谱β-内酰胺酶肠杆菌科细菌(ESBL)和耐碳青霉烯类肠杆菌科细菌(CRE),记录了它们的流行情况、传播模式和治疗结果。经济影响评估表明,由于耐药感染,全球每年的医疗保健费用超过1000亿美元。该综述指出了当前监测系统存在的重大差距,尤其是在低收入和中等收入国家,并提出了监测和控制策略的标准化方法。我们评估了各种抗菌药物管理计划的有效性,记录了不同医疗环境下的成功率和实施挑战。分析最后提出了基于证据的政策改革、研究重点和国际合作框架建议,以应对这一日益严重的全球健康危机。我们的研究结果强调了加强管理努力、提出新型诊断和治疗干预措施以及解决不同国家在获得医疗服务和数据方面的不平等问题的重要性。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/332e/12101290/bfcee4be321f/epidemiologia-06-00021-g001.jpg

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