PDF(Pubmed)
Abstract：
The understanding of antibiotic resistance, one of the major health threats of our time, is mostly based on dated and incomplete notions, especially in clinical contexts. The \"canonical\" mechanisms of action and pharmacodynamics of antibiotics, as well as the methods used to assess their activity upon bacteria, have not changed in decades; the same applies to the definition, acquisition, selective pressures, and drivers of resistance. As a consequence, the strategies to improve antibiotic usage and overcome resistance have ultimately failed. This review gathers most of the \"non-canonical\" notions on antibiotics and resistance: from the alternative mechanisms of action of antibiotics and the limitations of susceptibility testing to the wide variety of selective pressures, lateral gene transfer mechanisms, ubiquity, and societal factors maintaining resistance. Only by having a \"big picture\" view of the problem can adequate strategies to harness resistance be devised. These strategies must be global, addressing the many aspects that drive the increasing prevalence of resistant bacteria aside from the clinical use of antibiotics.
摘要：
对抗生素耐药性的理解，我们这个时代的主要健康威胁之一，主要是基于过时和不完整的概念，尤其是在临床环境中。抗生素的“规范”作用机制和药效学，以及用于评估它们对细菌的活性的方法，几十年来没有改变；这同样适用于定义，收购,选择性压力，和抵抗的驱动力。因此,改善抗生素使用和克服耐药性的策略最终失败了.这篇综述收集了大多数关于抗生素和耐药性的“非规范”概念：从抗生素的替代作用机制和敏感性测试的局限性到各种选择压力，横向基因转移机制，无处不在，和维持抵抗力的社会因素。只有对问题有“全局”的看法，才能设计出适当的策略来利用阻力。这些战略必须是全球性的，除了抗生素的临床使用外，还解决了导致耐药细菌日益流行的许多方面。
