Jens Rolff, Sebastian Bonhoeffer, Charlotte Kloft, Rasmus Leistner, Roland Regoes, Michael E Hochberg
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引用次数: 0
Abstract
Antimicrobial resistance (AMR) is a major global health issue. Current measures for tackling it comprise mainly the prudent use of drugs, the development of new drugs, and rapid diagnostics. Relatively little attention has been given to forecasting the evolution of resistance. Here, we argue that forecasting has the potential to be a great asset in our arsenal of measures to tackle AMR. We argue that, if successfully implemented, forecasting resistance will help to resolve the antibiotic crisis in three ways: it will (i) guide a more sustainable use (and therefore lifespan) of antibiotics and incentivize investment in drug development, (ii) reduce the spread of AMR genes and pathogenic microbes in the environment and between patients, and (iii) allow more efficient treatment of persistent infections, reducing the continued evolution of resistance. We identify two important challenges that need to be addressed for the successful establishment of forecasting: (i) the development of bespoke technology that allows stakeholders to empirically assess the risks of resistance evolving during the process of drug development and therapeutic/preventive use, and (ii) the transformative shift in mindset from the current praxis of mostly addressing the problem of antibiotic resistance a posteriori to a concept of a priori estimating, and acting on, the risks of resistance.
抗菌药耐药性(AMR)是一个重大的全球健康问题。目前的应对措施主要包括谨慎用药、开发新药和快速诊断。人们对耐药性演变的预测关注相对较少。在此,我们认为,预测有可能成为我们应对 AMR 的措施库中的一项重要资产。我们认为,如果能够成功实施,抗药性预测将有助于从三个方面解决抗生素危机:(i) 指导更可持续地使用抗生素(从而延长抗生素的寿命),激励对药物开发的投资;(ii) 减少 AMR 基因和病原微生物在环境中和病人之间的传播;(iii) 更有效地治疗顽固性感染,减少抗药性的持续演变。我们发现,要成功建立预测机制,需要应对两个重要挑战:(i) 开发定制技术,使利益相关者能够在药物开发和治疗/预防使用过程中对耐药性演变的风险进行经验评估;(ii) 转变观念,从目前主要在事后解决抗生素耐药性问题的做法转变为事先估计耐药性风险并采取相应行动的理念。
期刊介绍:
Trends in Microbiology serves as a comprehensive, multidisciplinary forum for discussing various aspects of microbiology, spanning cell biology, immunology, genetics, evolution, virology, bacteriology, protozoology, and mycology. In the rapidly evolving field of microbiology, technological advancements, especially in genome sequencing, impact prokaryote biology from pathogens to extremophiles, influencing developments in drugs, vaccines, and industrial enzyme research.