Rodney James, Laura Y. Hardefeldt, Courtney Ierano, Esmita Charani, Leslie Dowson, Sri Elkins, Karin Thursky
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引用次数: 0
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.
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.