(国家食品安全风险评估中心 国家卫生健康委员会食品安全风险评估重点实验室, 北京 100022)
(National Health Commission Key Laboratory of Food Safety Risk Assessment,China National Center for Food Safety Risk Assessment,Beijing 100022,China)
抗微生物药物耐药性(antimicrobial resistance,AMR)涉及兽医、食品、环境、医学等多个领域,危及食品安全、国际贸易、经济发展和生命健康,已成为全球面临的重大公共卫生问题。我国是全球最大的抗微生物药物生产和消费国,其中约60%的抗微生物药物被用于养殖业。由于抗微生物药物在养殖业的广泛使用甚至滥用,导致大量耐药细菌的出现和迅速传播。遵循“One Health”策略,联合国鼓励各国建立跨部门间的AMR协调机制。研究比较了中美欧食源性细菌耐药性监测系统的发展、框架及部分监测结果,发现各国监测体系基本涵盖人群、食品动物和相关食品食源性细菌耐药性,同时也监测人医和食品动物抗微生物药物使用量。欧美国家和地区起步较早,通过近30多年的发展,基本掌握了食源性细菌耐药性的基线水平及药物使用水平。我国食源性细菌耐药性监测体系起步较晚,人群、食品动物和相关食品食源性细菌耐药性监测发展近20年,而食品动物抗生素药物使用量监测于2018年开始启动,各方面都需要进一步完善。欧盟监测体系实施跨部门协作机制,数据共享共用；目前,虽然我国已经建立了不同部门负责的食源性细菌耐药性监测体系,但尚未建立数据共享机制,存在数据“烟囱”和信息孤岛,无法最大化发挥现有数据资源的效用。欧美经验对我国食源性细菌耐药性监测系统有一定启发:我国应逐步完善耐药监测系统、建立多部门协同共治机制及加快新技术在数据挖掘中的运用,从而综合提升遏制细菌耐药性的能力,保障人民健康。
Antimicrobial resistance (AMR) is involved in veterinary medicine, food, environment, medicine, and other fields. It endangers food safety, international trade, economic development, and life health. It has become a major public health problem facing the world. China was the world's largest producer and consumer of antimicrobials, about 60% of which were used in breeding industry. Due to its wide spread use and abuse in the breeding industry, many antimicrobial resistant bacteria appeared and spreaded rapidly. Following the “One Health” strategy, the United Nations encouraged countries to establish cross-sectoral AMR coordination mechanisms. This research compared the development, framework, and some monitoring results of foodborne bacterial antimicrobial resistance surveillance systems in China, the United States, and Europe. National surveillance systems basically covered population and food animal and food-related foodborne bacterial antimicrobial resistance, while also monitoring the use of antimicrobials in human medicine and food animals. American and European countries and regions started earlier and had relatively perfect systems. Through the development of nearly 30 years, they have mastered the baseline level of drug resistance and drug use of foodborne bacteria. Furthermore, scientific evaluation of surveillance data can play a risk management role, like optimizing surveillance programs (such as increasing surveillance of antimicrobial resistance in pets and environmental monitoring) and proposing interventions to limit the spread of resistant bacteria. The surveillance system of foodborne bacterial antimicrobial resistance started late in China. The surveillance of foodborne bacterial antimicrobial resistance in humans, food animals and related foods developed rapidly for 20 years, while the monitoring of antibiotic drug use in food animals began in 2018, and further improvement was needed for all aspects. At the same time, the EU monitoring system implemented the mechanism of breaking down departments to achieve data sharing. At present, different departments responsible for foodborne bacteria antimicrobial resistance monitoring systems have been established in our country. However, the data sharing mechanism has not been realized, and data “chimney” and information isolated island existed, which made it impossible to maximize the utility of existing data resources. By discussing the experiences of the United States and Europe, this research has the following inspirations for the antimicrobial resistance surveillance system in China. It is necessary to gradually improve the antimicrobial resistance surveillance system, establish a multi-sectoral collaborative governance mechanism, and accelerate the application of new technologies in data mining, to comprehensively improve the ability to curb bacterial resistance and protect people's health.