抗微生物药物耐药性风险评估研究进展

Risk assessment of antimicrobial resistance

梳理了国内外AMR风险评估的发展历程,系统综述了风险评估通用流程及常用方法.在政府机构层面,由于均缺乏关键的变量数据,目前只能针对特定的耐药菌或者耐药基因利用模型获取关键数据开展以定性为主的风险评估.在科学研究层面,AMR的风险评估不断完善,从分别针对单一的耐药菌、可移动遗传元件、耐药基因和毒力因子等发展到对其共现性的关注,再细化到基于耐药菌和耐药基因等权重的综合评估.基于上述分析,总结了目前AMR风险评估中存在的主要问题以及剂量-效应模型、基因型对照、监测数据获取缺乏等挑战,以期为中国AMR的风险评估和控制提供基础支撑.

The effectiveness of antimicrobial drugs is threatened by the increasing antimicrobial resistance (AMR).The development process of AMR risk assessment is systematically reviewed both domestically and internationally,and the general assessing processes and commonly used methods are summarized and analysed in this work as well.From the viewpoint of the government agency,only qualitative risk assessments can be conducted for specific drug-resistant bacteria or genes using models currently,which is mainly due to the lack of key variable data related with AMR in the environmental medium.As to the perspective of scientific research,the risk assessment of AMR has been continuously improved.It evolved from focusing on single drug-resistant bacteria,mobile genetic elements,drug-resistant genes,or virulence factors to paying attention to their co-occurrence integrally.Furthermore,comprehensive assessments based on the weights of drug-resistant bacteria and antibiotic resistance genes are also regarded.Based on the above analysis,this study concludes the main problems in current risk assessment of AMR.Moreover,challenges are put forward including lack of dose-response models,genotype control,and monitoring data acquisition of AMR.These findings will provide basic support for risk assessment and control of AMR in China.