Antimicrobial stewardship from a One Health perspective

IF 103.3 1区 生物学 Q1 MICROBIOLOGY
Rodney James, Laura Y. Hardefeldt, Courtney Ierano, Esmita Charani, Leslie Dowson, Sri Elkins, Karin Thursky
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Abstract

The global rise of antimicrobial resistance (AMR) poses a profound threat to human, animal and environmental health. Although antimicrobials have revolutionized modern medicine, their overuse and misuse have accelerated AMR, necessitating urgent, multisectoral action. Antimicrobial stewardship (AMS), a set of coordinated strategies that promote responsible antimicrobial use, has emerged as a key intervention in managing AMR. In this Review, we explore AMS within a One Health framework, emphasizing interconnectedness across sectors. We examine clinical, economic, sociocultural and environmental drivers of antimicrobial use, highlighting disparities between high-income and low-income settings and identifying context-specific challenges to implementation. We also discuss the importance of governance, financing, digital innovation, surveillance and behavioural science in shaping sustainable AMS programmes, and we consider core components, such as policy integration, surveillance of appropriateness, and context-aware interventions. This Review ultimately advocates for equity-focused strategies that better account for structural barriers, support marginalized populations, and ensure global access to high-quality antimicrobials. By aligning political will, funding and scientific innovation, AMS programmes can be scaled effectively to preserve antimicrobial efficacy, mitigate AMR, improve health outcomes, and promote global health security. The paper concludes with key recommendations for embedding AMS across sectors as a sustainable response to AMR.

Abstract Image

从同一个健康的角度看抗菌剂管理
全球抗菌素耐药性(AMR)的上升对人类、动物和环境健康构成了严重威胁。尽管抗微生物药物彻底改变了现代医学,但它们的过度使用和误用加速了抗菌素耐药性,需要采取紧急的多部门行动。抗微生物药物管理是一套促进负责任地使用抗微生物药物的协调战略,已成为管理抗微生物药物耐药性的一项关键干预措施。在这篇综述中,我们在一个健康框架内探索AMS,强调跨部门的相互联系。我们研究了抗菌药物使用的临床、经济、社会文化和环境驱动因素,强调了高收入和低收入环境之间的差异,并确定了具体实施的挑战。我们还讨论了治理、融资、数字创新、监测和行为科学在塑造可持续医疗辅助计划中的重要性,并考虑了政策整合、适当性监测和情境感知干预等核心组成部分。本综述最终倡导以公平为重点的战略,更好地解决结构性障碍,支持边缘化人群,并确保全球获得高质量的抗微生物药物。通过协调政治意愿、资金和科学创新,辅助药物治疗规划可以有效地扩大规模,以保持抗微生物药物功效,减轻抗微生物药物耐药性,改善卫生结果,促进全球卫生安全。该报告最后提出了跨部门纳入抗微生物药物耐药性的关键建议,作为对抗微生物药物耐药性的可持续反应。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Nature Reviews Microbiology
Nature Reviews Microbiology 生物-微生物学
CiteScore
74.00
自引率
0.50%
发文量
149
审稿时长
6-12 weeks
期刊介绍: At Nature Reviews Microbiology, our goal is to become the leading source of reviews and commentaries for the scientific community we cater to. We are dedicated to publishing articles that are not only authoritative but also easily accessible, supplementing them with clear and concise figures, tables, and other visual aids. Our objective is to offer an unparalleled service to authors, referees, and readers, and we continuously strive to maximize the usefulness and impact of each article we publish. With a focus on Reviews, Perspectives, and Comments spanning the entire field of microbiology, our wide scope ensures that the work we feature reaches the widest possible audience.
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