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抗菌药物耐药性综合征:非传染性疾病、社会剥夺与多重耐药感染的兴起

Syndemics of Antimicrobial Resistance: Non-communicable Diseases, Social Deprivation, and the Rise of Multidrug-Resistant Infections.

作者信息

Abdul-Mutakabbir Jacinda C, Abdul-Mutakabbir Raheem

机构信息

Division of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, 9500 Gilman Drive, MC 0657, La Jolla, CA, 92093-0657, USA.

Division of the Black Diaspora and African American Studies, University of California San Diego, La Jolla, CA, 92093, USA.

出版信息

Infect Dis Ther. 2025 Jul 3. doi: 10.1007/s40121-025-01188-1.

Abstract

Antimicrobial resistance (AMR) constitutes a global health emergency that results in significant morbidity, mortality, and economic burden. Despite its severity, this issue remains inadequately addressed in public health discussions worldwide. This commentary employs a syndemic perspective to explore the synergistic relationship between multidrug-resistant (MDR) infections and non-communicable chronic diseases (NCDs). NCDs, including cardiovascular disease, chronic respiratory conditions, cancer, and diabetes mellitus, are prevalent among socially deprived populations, creating conditions that facilitate bacterial colonization and worsen disease severity, thus heightening the risk of infection and resulting in poorer clinical outcomes. Conversely, MDR infections can also exacerbate NCDs by provoking inflammatory responses and disrupting homeostasis. The commentary further underscores how social determinants of health (SDoH), such as economic hardship, limited access to healthcare, and lower educational attainment, intensify this syndemic relationship, particularly in low- and middle-income countries (LMICs) and among socially deprived populations in high-income countries. In conclusion, we provide actionable recommendations for clinicians to consider when identifying and addressing syndemics in AMR. Embracing a syndemic approach to combat AMR may yield more effective strategies to alleviate the AMR "silent pandemic," especially benefiting populations disproportionately impacted by overlapping social, economic, and health vulnerabilities.

摘要

抗菌药物耐药性(AMR)构成了一场全球卫生紧急事件,导致了严重的发病、死亡和经济负担。尽管其严重性,但这个问题在全球公共卫生讨论中仍未得到充分解决。本评论采用共病视角来探讨多重耐药(MDR)感染与非传染性慢性病(NCDs)之间的协同关系。非传染性慢性病,包括心血管疾病、慢性呼吸道疾病、癌症和糖尿病,在社会弱势群体中普遍存在,创造了有利于细菌定植并加重疾病严重程度的条件,从而增加了感染风险并导致较差的临床结果。相反,多重耐药感染也可通过引发炎症反应和破坏体内平衡来加重非传染性慢性病。该评论进一步强调了健康的社会决定因素(SDoH),如经济困难、获得医疗保健的机会有限和教育程度较低,如何加剧这种共病关系,特别是在低收入和中等收入国家(LMICs)以及高收入国家的社会弱势群体中。总之,我们为临床医生在识别和应对抗菌药物耐药性中的共病时提供了可行的建议。采用共病方法来对抗抗菌药物耐药性可能会产生更有效的策略来缓解抗菌药物耐药性这一“无声的大流行”,尤其有利于那些受到社会、经济和健康多重脆弱性影响 disproportionately 的人群。

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