PDF(Pubmed)
Abstract：
Third generation cephalosporins and carbapenems are considered critically important antimicrobials in human medicine. Food animals such as swine can act as reservoirs of antimicrobial resistance (AMR) genes/bacteria resistant to these antimicrobial classes, and potential dissemination of AMR genes or resistant bacteria from pigs to humans is an ongoing public health threat. The objectives of this systematic review and meta-analysis were to: (1) estimate global proportion and animal-level prevalence of swine E. coli phenotypically resistant to third generation cephalosporins (3GCs) and carbapenems at a country level; and (2) measure abundances and global distribution of the genetic mechanisms that confer resistance to these antimicrobial classes in these E. coli isolates. Articles from four databases (CAB Abstracts, PubMed/MEDLINE, PubAg, and Web of Science) were screened to extract relevant data. Overall, proportion of E. coli resistant to 3GCs was lower in Australia, Europe, and North America compared to Asian countries. Globally, <5% of all E. coli were carbapenem-resistant. Fecal carriage rates (animal-level prevalence) were consistently manifold higher as compared to pooled proportion of resistance in E. coli isolates. bla CTX-M were the most common 3GC resistance genes globally, with the exception of North America where bla CMY were the predominant 3GC resistance genes. There was not a single dominant bla CTX-M gene subtype globally and several bla CTX-M subtypes were dominant depending on the continent. A wide variety of carbapenem-resistance genes (bla NDM-, VIM-, IMP-, OXA-48, and KPC-) were identified to be circulating in pig populations globally, albeit at very-low frequencies. However, great statistical heterogeneity and a critical lack of metadata hinders the true estimation of prevalence of phenotypic and genotypic resistance to these antimicrobials. Comparatively frequent occurrence of 3GC resistance and emergence of carbapenem resistance in certain countries underline the urgent need for improved AMR surveillance in swine production systems in these countries.
摘要：
第三代头孢菌素和碳青霉烯类被认为是人类医学中至关重要的抗菌药物。食用动物，如猪可以作为抗微生物药物耐药性（AMR）基因/细菌对这些抗微生物药物具有抗性，和AMR基因或耐药细菌从猪到人类的潜在传播是一个持续的公共卫生威胁。本系统综述和荟萃分析的目的是：（1）在国家一级估计对第三代头孢菌素（3GC）和碳青霉烯类耐药的猪大肠杆菌的全球比例和动物水平流行率；（2）测量在这些大肠杆菌分离株中赋予这些抗菌类别耐药性的遗传机制的丰度和全球分布。来自四个数据库的文章(CAB摘要，PubMed/MEDLINE,PubAg,和WebofScience)进行筛选以提取相关数据。总的来说,在澳大利亚，大肠杆菌对3GC耐药的比例较低，欧洲,和北美相比，亚洲国家。全球范围内,所有大肠杆菌中<5%是碳青霉烯抗性的。与大肠杆菌分离株中的合并耐药比例相比，粪便携带率（动物水平的患病率）始终较高。blaCTX-M是全球最常见的3GC抗性基因，北美除外，其中blaCMY是主要的3GC抗性基因。全球范围内没有一个显性的blaCTX-M基因亚型，根据大陆的不同，有几个blaCTX-M亚型占主导地位。各种各样的碳青霉烯抗性基因(blaNDM-，VIM-,Ip-,OXA-48和KPC-）被确定在全球猪种群中循环，尽管频率很低。然而,巨大的统计异质性和严重的元数据缺乏阻碍了对这些抗菌药物的表型和基因型耐药性患病率的真实估计.在某些国家，3GC耐药性的发生和碳青霉烯耐药性的出现相对频繁，突显了这些国家迫切需要改善猪生产系统中的AMR监测。
