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文献精选 > 近年高分"mRNA疫苗"研究（IF≥30，近5年）

The role of vaccines in combatting antimicrobial resistance. ​

文献信息 ​

DOI10.1038/s41579-020-00506-3
PMID33542518
期刊Nature reviews. Microbiology
影响因子103.3
JCR 分区Q1
发表年份2021
被引次数190
关键词疫苗, 抗微生物耐药性, 细菌感染, 预防策略, 药物耐药性
文献类型Journal Article, Review
ISSN1740-1526
页码287-302
期号19(5)
作者Francesca Micoli, Fabio Bagnoli, Rino Rappuoli, Davide Serruto

一句话小结 ​

本综述探讨了抗微生物耐药性（AMR）对全球健康构成的威胁，以及疫苗在减少感染病例、降低抗生素使用和抗耐药性传播中的潜在作用。研究表明，开发针对主要耐药病原体的疫苗不仅能够改善公共卫生，还能应对多重耐药性带来的挑战。

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疫苗 · 抗微生物耐药性 · 细菌感染 · 预防策略 · 药物耐药性

摘要 ​

抗生素的使用使得细菌感染的成功治疗成为可能，拯救了全球许多患者的生命并改善了他们的健康。然而，各种卫生组织已指出抗微生物耐药性（AMR）的出现和传播是一个全球性威胁，耐药病原体导致了显著的发病率和死亡率。随着多重耐药性的增加，需要新的有效疗法以及预防策略。在本综述中，我们讨论了疫苗在对抗抗微生物耐药性方面可能发挥的重要作用的证据。疫苗用于预防性接种，减少感染性疾病的病例数量，从而降低抗生素的使用以及抗微生物耐药性的出现和传播。我们还描述了针对在高收入国家和低中收入国家造成重大疾病负担的耐药细菌病原体的疫苗开发的当前状况，讨论了阻碍疫苗研发进展的可能障碍，并推测下一代疫苗在对抗细菌感染性疾病方面对抗微生物耐药性的影响。

英文摘要 ​

The use of antibiotics has enabled the successful treatment of bacterial infections, saving the lives and improving the health of many patients worldwide. However, the emergence and spread of antimicrobial resistance (AMR) has been highlighted as a global threat by different health organizations, and pathogens resistant to antimicrobials cause substantial morbidity and death. As resistance to multiple drugs increases, novel and effective therapies as well as prevention strategies are needed. In this Review, we discuss evidence that vaccines can have a major role in fighting AMR. Vaccines are used prophylactically, decreasing the number of infectious disease cases, and thus antibiotic use and the emergence and spread of AMR. We also describe the current state of development of vaccines against resistant bacterial pathogens that cause a substantial disease burden both in high-income countries and in low- and medium-income countries, discuss possible obstacles that hinder progress in vaccine development and speculate on the impact of next-generation vaccines against bacterial infectious diseases on AMR.

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主要研究问题 ​

  1. 疫苗如何具体降低抗生素的使用，从而减缓抗微生物耐药性的传播？
  2. 当前针对抗药性细菌病原体的疫苗开发进展如何？有哪些成功案例？
  3. 除了疫苗，还有哪些其他有效的预防策略可以对抗抗微生物耐药性？
  4. 在不同收入国家中，疫苗对抗微生物耐药性的影响是否存在显著差异？如何解决这些差异？
  5. 下一代疫苗在抗击细菌感染和减少抗微生物耐药性方面的潜在影响是什么？

核心洞察 ​

研究背景和目的 ​

抗微生物耐药性（AMR）已成为全球公共卫生的重大挑战。随着抗生素的广泛使用，许多细菌已经演变出抗药性。疫苗被认为是对抗AMR的潜在策略之一。本研究旨在探讨疫苗在抗微生物耐药性中的作用，特别是如何通过预防感染来减少抗生素的使用，从而降低耐药性的发展。

主要方法/材料/实验设计 ​

本研究通过文献综述和病例分析，分析了不同病原体的抗药性机制及其与疫苗研发的关系。研究重点在于不同细菌的耐药机制、流行病学数据以及当前疫苗研发的进展。

Mermaid diagram

关键结果和发现 ​

  1. 抗药性机制：细菌通过多种机制获得抗药性，包括减少抗生素的进入、修改抗生素靶点以及酶的产生来灭活抗生素。
  2. 主要病原体：
    • Clostridioides difficile：抗生素治疗导致肠道菌群失衡，增加复发风险。
    • Escherichia coli：社区获得性尿路感染的主要致病菌，耐药性逐渐增加。
    • Staphylococcus aureus：引起医院获得性感染，耐甲氧西林金黄色葡萄球菌（MRSA）频繁出现。
    • Neisseria gonorrhoeae：发展出广泛的抗药性，被称为“超级细菌”。
    • Pseudomonas aeruginosa和Klebsiella pneumoniae：在医院感染中表现出多重耐药性。

主要结论/意义/创新性 ​

本研究表明，疫苗可以通过减少感染率来间接降低抗生素的使用，从而减缓抗药性的扩散。开发针对主要耐药病原体的疫苗是应对AMR的关键策略之一。尽管目前许多疫苗仍在研发阶段，但已有一些候选疫苗显示出良好的前景。

研究局限性和未来方向 ​

  1. 局限性：研究主要依赖文献综述，缺乏大规模临床试验数据支持。
  2. 未来方向：需要更多针对不同耐药病原体的临床试验，以验证疫苗的有效性。同时，促进全球合作以加速疫苗研发，尤其是在资源有限的国家。

表格总结 ​

病原体主要耐药机制当前疫苗研发状态
Clostridioides difficile抗生素导致菌群失衡进行中
Escherichia coli多重耐药性进行中
Staphylococcus aureusMRSA的出现进行中
Neisseria gonorrhoeae抗药性广泛进行中
Pseudomonas aeruginosa多重耐药性进行中
Klebsiella pneumoniae抗生素耐药性进行中

通过上述研究，可以看出疫苗在抗微生物耐药性中的潜在应用前景，以及继续推动疫苗研发的重要性。

参考文献 ​

  1. Action and resistance mechanisms of antibiotics: A guide for clinicians. - Garima Kapoor;Saurabh Saigal;Ashok Elongavan - Journal of anaesthesiology, clinical pharmacology (2017)
  2. Correlation between antimicrobial consumption and antimicrobial resistance of Pseudomonas aeruginosa in a hospital setting: a 10-year study. - S Mladenovic-Antic;B Kocic;R Velickovic-Radovanovic;M Dinic;J Petrovic;G Randjelovic;R Mitic - Journal of clinical pharmacy and therapeutics (2016)
  3. Measuring and mapping the global burden of antimicrobial resistance. - Simon I Hay;Puja C Rao;Christiane Dolecek;Nicholas P J Day;Andy Stergachis;Alan D Lopez;Christopher J L Murray - BMC medicine (2018)
  4. Antibiotic resistance: a rundown of a global crisis. - Bilal Aslam;Wei Wang;Muhammad Imran Arshad;Mohsin Khurshid;Saima Muzammil;Muhammad Hidayat Rasool;Muhammad Atif Nisar;Ruman Farooq Alvi;Muhammad Aamir Aslam;Muhammad Usman Qamar;Muhammad Khalid Farooq Salamat;Zulqarnain Baloch - Infection and drug resistance (2018)
  5. Vaccines: An achievement of civilization, a human right, our health insurance for the future. - Rino Rappuoli;Angela Santoni;Alberto Mantovani - The Journal of experimental medicine (2019)
  6. Why the evolution of vaccine resistance is less of a concern than the evolution of drug resistance. - David A Kennedy;Andrew F Read - Proceedings of the National Academy of Sciences of the United States of America (2018)
  7. Technologies to address antimicrobial resistance. - Stephen J Baker;David J Payne;Rino Rappuoli;Ennio De Gregorio - Proceedings of the National Academy of Sciences of the United States of America (2018)
  8. Impact of existing vaccines in reducing antibiotic resistance: Primary and secondary effects. - Keith P Klugman;Steven Black - Proceedings of the National Academy of Sciences of the United States of America (2018)
  9. The role of vaccines in preventing bacterial antimicrobial resistance. - Kathrin U Jansen;Charles Knirsch;Annaliesa S Anderson - Nature medicine (2018)
  10. Attributable deaths and disability-adjusted life-years caused by infections with antibiotic-resistant bacteria in the EU and the European Economic Area in 2015: a population-level modelling analysis. - Alessandro Cassini;Liselotte Diaz Högberg;Diamantis Plachouras;Annalisa Quattrocchi;Ana Hoxha;Gunnar Skov Simonsen;Mélanie Colomb-Cotinat;Mirjam E Kretzschmar;Brecht Devleesschauwer;Michele Cecchini;Driss Ait Ouakrim;Tiago Cravo Oliveira;Marc J Struelens;Carl Suetens;Dominique L Monnet; - The Lancet. Infectious diseases (2019)

引用本文的文献 ​

  1. Prophylaxis and Treatment against Klebsiella pneumoniae: Current Insights on This Emerging Anti-Microbial Resistant Global Threat. - Vanessa Arato;Maria Michelina Raso;Gianmarco Gasperini;Francesco Berlanda Scorza;Francesca Micoli - International journal of molecular sciences (2021)
  2. Fighting Antibiotic Resistance in Hospital-Acquired Infections: Current State and Emerging Technologies in Disease Prevention, Diagnostics and Therapy. - Ekaterina Avershina;Valeria Shapovalova;German Shipulin - Frontiers in microbiology (2021)
  3. Bacterial Outer Membrane Vesicles as a Versatile Tool in Vaccine Research and the Fight against Antimicrobial Resistance. - Zhuang Zhu;Fabio Antenucci;Kasper Rømer Villumsen;Anders Miki Bojesen - mBio (2021)
  4. Antimicrobial Peptides: A Potent Alternative to Antibiotics. - Mariam Rima;Mohamad Rima;Ziad Fajloun;Jean-Marc Sabatier;Burkhard Bechinger;Thierry Naas - Antibiotics (Basel, Switzerland) (2021)
  5. Nanovaccines against Animal Pathogens: The Latest Findings. - Carmen Teresa Celis-Giraldo;Julio López-Abán;Antonio Muro;Manuel Alfonso Patarroyo;Raúl Manzano-Román - Vaccines (2021)
  6. Survey among Italian experts on existing vaccines' role in limiting antibiotic resistance. - Federico Marchetti;Rosa Prato;Pierluigi Viale - Human vaccines & immunotherapeutics (2021)
  7. Multivalent poultry vaccine development using Protein Glycan Coupling Technology. - Marta Mauri;Thippeswamy H Sannasiddappa;Prerna Vohra;Ricardo Corona-Torres;Alexander A Smith;Cosmin Chintoan-Uta;Abi Bremner;Vanessa S Terra;Sherif Abouelhadid;Mark P Stevens;Andrew J Grant;Jon Cuccui;Brendan W Wren; - Microbial cell factories (2021)
  8. Towards A Novel Multi-Epitopes Chimeric Vaccine for Simulating Strong Immune Responses and Protection against Morganella morganii. - Asad Ullah;Sajjad Ahmad;Saba Ismail;Zobia Afsheen;Muhammad Khurram;Muhammad Tahir Ul Qamar;Naif AlSuhaymi;Mahdi H Alsugoor;Khaled S Allemailem - International journal of environmental research and public health (2021)
  9. Manifesto on the Value of Adult Immunization: "We Know, We Intend, We Advocate". - Raffaele Antonelli-Incalzi;Francesco Blasi;Michele Conversano;Giovanni Gabutti;Sandro Giuffrida;Stefania Maggi;Cinzia Marano;Alessandro Rossi;Marta Vicentini - Vaccines (2021)
  10. The role of vaccines in combating antimicrobial resistance (AMR) bacteria. - Saad Alghamdi - Saudi journal of biological sciences (2021)

... (180 更多 篇文献)

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