Davies J
Department of Microbiology, University of British Columbia, Vancouver, Canada.
Microbiologia. 1994 Mar-Jun;10(1-2):9-12.
In the past fifty years the treatment and ecology of infectious diseases has evolved greatly. The major changes have come as the development of "new" pathogens which are usually "old" pathogens in new guises. The chief environmental factor responsible for this change is the use of antimicrobial agents. It is estimated that more than 10(9) kg of antibiotic have been produced and used since the early 1959's. In spite of this threat, bacterial pathogens have not only survived, but even flourished. It is now too late to reverse this trend, since the treatment of infectious diseases relies heavily on antibiotics and there is a well-established pool of antibiotic resistance genes in nature. Hospital are unique, varied ecological niches for microbial diversity, and we know little about where resistance genes come from or the pathways by which these genes are passed around the bacterial population. Since less than 10% of the bacterial species on earth can be identified, we are ignorant of a large component of the factors responsible for health, disease and antibiotic resistance. What can we look forward to? There has been much talk of reemerging pathogens such as Mycobacterium tuberculosis, Listeria monocytogenes, enterococci and various fungi. These organisms have surfaced because of their ability to survive in hostile environments (antibiotics, antiseptics). We should anticipate the reappearance of other such organisms, and clinicians and the pharmaceutical industry should be prepared for this. Now it is the time to get profit from the lessons of the past, which, together with better knowledge of microbial biochemistry and ecology, must be applied to the problems of infectious diseases.
在过去的五十年里，传染病的治疗和生态学发生了巨大的演变。主要的变化源于“新”病原体的出现，而这些病原体通常是换了新面貌的“旧”病原体。造成这种变化的主要环境因素是抗菌剂的使用。据估计，自20世纪50年代初以来，已生产和使用了超过10⁹千克的抗生素。尽管存在这种威胁，细菌病原体不仅存活了下来，甚至还大量繁殖。现在要扭转这一趋势已经太晚了，因为传染病的治疗严重依赖抗生素，而且自然界中已经存在大量的抗生素抗性基因库。医院是微生物多样性独特且多样的生态位，我们对抗性基因的来源以及这些基因在细菌群体中传播的途径知之甚少。由于地球上不到10% 的细菌物种能够被识别，我们对影响健康、疾病和抗生素抗性的很大一部分因素一无所知。我们能期待什么呢？人们已经多次谈论诸如结核分枝杆菌、单核细胞增生李斯特菌、肠球菌和各种真菌等重新出现的病原体。这些生物体之所以出现，是因为它们有能力在恶劣环境（抗生素、防腐剂）中存活。我们应该预料到其他此类生物体的再次出现，临床医生和制药行业应该为此做好准备。现在是从过去的经验教训中获利的时候了，这些经验教训，连同对微生物生物化学和生态学的更深入了解，必须应用于传染病问题。
