美国应对细菌耐药国家行动计划

MARCH2015NATIONALACTIONPLANFORCOMBATINGANTIBIOTIC-RESISTANTBACTERIA1★★TableofContentsExecutiveSummary................................2Introduction...................................4Goals1.SlowtheEmergenceofResistantBacteriaandPreventtheSpreadofResistantInfections...............................112.StrengthenNationalOne-HealthSurveillanceEffortstoCombatResistance.....243.AdvanceDevelopmentandUseofRapidandInnovativeDiagnosticTestsforIdentificationandCharacterizationofResistantBacteria.............364.AccelerateBasicandAppliedResearchandDevelopmentforNewAntibiotics,OtherTherapeutics,andVaccines......................405.ImproveInternationalCollaborationandCapacitiesforAntibiotic-resistancePrevention,Surveillance,Control,andAntibioticResearchandDevelopment.....49Tables1.NationalTargetsforCombatingAntibiotic-ResistantBacteria...........62.GoalsandObjectives...........................93.Antibiotic-ResistantThreatsintheUnitedStates................60Appendix...................................602★★ExecutiveSummaryAntibioticshavebeenacriticalpublichealthtoolsincethediscoveryofpenicillinin1928,savingthelivesofmillionsofpeoplearoundtheworld.Today,however,theemergenceofdrugresistanceinbacteriaisreversingthemiraclesofthepasteightyyears,withdrugchoicesforthetreatmentofmanybacterialinfectionsbecomingincreasinglylimited,expensive,and,insomecases,nonexistent.TheCentersforDiseaseControlandPrevention(CDC)estimatesthatdrug-resistantbacteriacausetwomillionillnessesandapproximately23,000deathseachyearintheUnitedStatesalone.TheNationalActionPlanforCombatingAntibiotic-resistantBacteriaprovidesaroadmaptoguidetheNationinrisingtothischallenge.DevelopedinresponsetoExecutiveOrder13676:CombatingAntibiotic-ResistantBacteria—issuedbyPresidentBarackObamaonSeptember18,2014—theNationalActionPlanoutlinesstepsforimplementingtheNationalStrategyforCombatingAntibiotic-ResistantBacteriaandaddressingthepolicyrecommendationsofthePresident’sCouncilofAdvisorsonScienceandTechnology(PCAST).AlthoughitsprimarypurposeistoguideactivitiesbytheU.S.Government,theNationalActionPlanisalsodesignedtoguideactionbypublichealth,healthcare,andveterinarypartnersinacommonefforttoaddressurgentandseriousdrug-resistantthreatsthataffectpeopleintheU.S.andaroundtheworld.ImplementationoftheNationalActionPlanwillalsosupportWorldHealthAssemblyresolution67.25(AntimicrobialResistance),whichurgescountriestotakeurgentactionatthenational,regional,andlocallevelstocombatresistance.ThegoalsoftheNationalActionPlaninclude:1.SlowtheEmergenceofResistantBacteriaandPreventtheSpreadofResistantInfections.2.StrengthenNationalOne-HealthSurveillanceEffortstoCombatResistance.3.AdvanceDevelopmentandUseofRapidandInnovativeDiagnosticTestsforIdentificationandCharacterizationofResistantBacteria.4.AccelerateBasicandAppliedResearchandDevelopmentforNewAntibiotics,OtherTherapeutics,andVaccines.5.ImproveInternationalCollaborationandCapacitiesforAntibiotic-resistancePrevention,Surveillance,Control,andAntibioticResearchandDevelopment.By2020,implementationoftheNationalActionPlanwillleadtomajorreductionsintheincidenceofurgentandseriousthreats,includingcarbapenem-resistantEnterobacteriaceae(CRE),methicillin-resistantStaphylococcusaureus(MRSA),andClostridiumdifficile(seeTable1).TheNationalActionPlanwillalsoresultinimprovedantibioticstewardshipinhealthcaresettings,preventionofthespreadofdrug-resistantthreats,eliminationoftheuseofmedically-importantantibioticsforgrowthpromotioninfoodanimals,andexpandedsurveillancefordrug-resistantbacteriainhumansandanimals.Othersignificantoutcomesincludecreationofaregionalpublichealthlaboratorynetwork,establishmentofaspecimenrepositoryandsequencedatabasethatcanbeaccessedbyindustrialandacademicresearch-ers,developmentofnewdiagnosticteststhroughanationalchallenge,anddevelopmentoftwoormore3★★NATIONALACTIONPLANFORCOMBATINGANTIBIOTIC-RESISTANTBACTERIAantibioticdrugcandidatesornon-traditionaltherapeuticsfortreatmentofhumandisease.Inaddition,theefforttocombatresistantbacteriawillbecomeaninternationalpriorityforglobalhealthsecurity.ProgresstowardsachievingtheseoutcomeswillbemonitoredbytheU.S.GovernmentTaskForcethatdevelopedtheNationalActionPlan.TheTaskForce,whichisco-chairedbytheSecretariesofDefense,Agriculture,andHealthandHumanServices,includesrepresentativesfromtheDepartmentsofState,Justice,VeteransAffairs,andHomelandSecurity,aswellastheEnvironmentalProtectionAgency,theUnitedStatesAgencyforInternationalDevelopment,theOfficeofManagementandBudget,theDomesticPolicyCouncil,theNationalSecurityCouncil,theOfficeofScienceandTechnologyPolicy,andtheNationalScienceFoundation.Additionally,thePresidentialAdvisoryCouncilonCombatingAntibiotic-ResistantBacteria,createdbyExecutiveOrder13676,willprovideadvice,information,andrecommendationstotheSecretaryofHealthandHumanServicesregardingtheNationalActionPlan’sprogramsandpoliciesandtheirimpactonthethreat.ImplementationoftheobjectivesandactivitiesintheNationalActionPlanrequiressustained,coordi-nated,andcomplementaryeffortsofindividualsandgroupsaroundtheworld,inc