Georges Rainier-Numa, Doumèche Bastien
Univ Lyon, Université Claude Bernard Lyon 1, CNRS, ICBMS UMR5246, 69622, Villeurbanne, France.
Arch Microbiol. 2025 May 29;207(7):162. doi: 10.1007/s00203-025-04340-0.
Over the past few decades, antibiotic resistance has emerged as a major global health concern and is projected to become the leading cause of mortality worldwide by 2050. The growing human population and global warming are expected to further exacerbate this issue by increasing interactions between humans and pathogenic organisms. Unlike other studies that focus on specific aspects of antibiotic resistance, the aim of this review is to provide a comprehensive overview of this complex topic and to identify the key challenges and unanswered questions arising from heterogeneous data, the lack of scientific consensus on critical definitions, and the widespread dissemination of resistance factors. Priority pathogens identified by the World Health Organization (WHO) are presented to illustrate the clinical manifestations and impact of multidrug-resistant strains. To maintain a consistent narrative throughout the review, two WHO priority pathogens (Haemophilus influenzae and Streptococcus pneumoniae), along with a potential future priority pathogen (Vibrio vulnificus), are used as guiding examples. The bacteria priority pathogens list published by the WHO, and those for fungi, were taken as a starting point for selecting human pathogens. Publications were then selected from Web of Science, PubMed, Scopus and sites of recognized scientific institutions. To include all pathogens with antibiotic resistance, including those not considered as priority by the WHO, V. vulnificus was added because it is already monitored by many international institutions. The selected publications have all been curated to ensure scientific relevance. Molecular aspects of pathogen antibiotic resistance in terms of emergence (e.g. target mutations) and transmission are obviously important factors to consider in the antibiotic resistance issue. Nevertheless, the versatility of definitions related to antibiotic resistance, along with the lack of resources, incomplete datasets, and insufficient standardization of data processing, clearly represent urgent challenges. Furthermore, studies of certain failed public health policies have also highlighted a lack of findings. Identifying challenges linked to antibiotic resistance will enable the scientific community, whether familiar with the subject or not, to understand medical infections issues and exchange ideas more extensively in order to find new innovative pharmacological and non-pharmacological solutions for treating patients. Finally, several diagnostics and therapeutic strategies currently developed for medical applications before 2050 are discussed at the end of this review.
在过去几十年中，抗生素耐药性已成为全球主要的健康问题，预计到2050年将成为全球死亡的主要原因。预计不断增长的人口和全球变暖将通过增加人类与致病生物之间的相互作用进一步加剧这一问题。与其他关注抗生素耐药性特定方面的研究不同，本综述的目的是全面概述这一复杂主题，并确定由异质数据、关键定义缺乏科学共识以及耐药因素广泛传播所引发的关键挑战和未解决问题。介绍了世界卫生组织（WHO）确定的优先病原体，以说明多重耐药菌株的临床表现和影响。为了在整个综述中保持连贯的叙述，选取了两种WHO优先病原体（流感嗜血杆菌和肺炎链球菌）以及一种潜在的未来优先病原体（创伤弧菌）作为指导示例。WHO公布的细菌优先病原体清单以及真菌的清单被作为选择人类病原体的起点。然后从科学网、PubMed、Scopus以及知名科研机构的网站中挑选出版物。为了纳入所有具有抗生素耐药性的病原体，包括那些未被WHO视为优先病原体的，添加了创伤弧菌，因为它已被许多国际机构监测。所选出版物均经过精心挑选以确保科学相关性。就出现（例如靶点突变）和传播而言，病原体抗生素耐药性的分子方面显然是抗生素耐药性问题中需要考虑的重要因素。然而与抗生素耐药性相关定义的多样性，以及资源匮乏、数据集不完整和数据处理标准化不足，显然是紧迫的挑战。此外某些失败的公共卫生政策研究也凸显了研究结果的匮乏。识别与抗生素耐药性相关的挑战将使科学界，无论是否熟悉该主题，都能更广泛地理解医学感染问题并交流想法，以便找到治疗患者的新的创新药理学和非药理学解决方案。最后，本综述末尾讨论了目前在2050年前为医学应用开发的几种诊断和治疗策略。
