現(xiàn)代醫(yī)學依靠有效的抗生素來控制細菌感染。自從這些神奇的藥物中的第一種問世僅在65年前，它們就改變了醫(yī)學的實踐并挽救了數(shù)百萬人的生命。但是今天，在21世紀初，對抗生素產生抗藥性的細菌病原體的迅速出現(xiàn)和傳播威脅著我們回到一個普通感染無法治愈的時代。耐藥性金黃色葡萄球菌（金黃色葡萄球菌或“葡萄球菌”）的日益嚴重的問題是可以說明的（圖ES.1）。在 1987年，有2％的金黃色葡萄球菌感染患者對甲氧西林沒有反應，甲氧西林是一種廉價的抗生素，自1960年代以來一直有效對抗這些感染。到2004年，超過50％的金黃色葡萄球菌患者對甲氧西林沒有反應，造成了可怕的后果。已經報道了幾例對萬古霉素耐藥的藥物，該藥物常用于治療MRSA感染。 肺炎鏈球菌（S. pneumoniae），另一種常見病原體，引起細菌性腦膜炎和細菌性 肺炎等疾病。 1987年，每10,000例肺炎鏈球菌感染中只有2例（0.02％）對青霉素（所選的抗生素）有抗藥性。到2004年，這一數(shù)字已上升到5％（即20％），增長了1000倍（CDC 2005）。 根據(jù)美國食品藥品監(jiān)督管理局（FDA）的說法，“除非能夠及時發(fā)現(xiàn)抗生素耐藥性問題并采取措施加以遏制，否則世界可能會面臨以前無法治愈的疾病，就像過去那樣在開發(fā)抗生素之前”（機構間抗菌素特別工作組 抵抗2001）。近年來的主要報道稱采取措施解決這一日益嚴重的威脅，然后再吞并醫(yī)療系統(tǒng)（ASM 1994； OTA 1995； Harrison and Lederberg 1998），但政策制定者卻采取了驚人的行動。 抗菌功效可以被視為一種天然資源， 很像石油，魚類或森林（Laxminarayan and Brown 2001; “世界可能面臨著以前無法治愈的可治愈疾病……” —抗菌素耐藥性機構間工作隊 Laxminarayan 2003）：任何人都可以使用的資源 可以購買。所有抗生素的使用，無論適當與否，都會“消耗”該抗生素的某些功效，從而削弱了我們將來使用該抗生素的能力。通過過度使用抗生素來加速耐藥性的傳播，就像其他人分享的一樣 資源問題，例如全球變暖或過度捕撈 這種現(xiàn)象被稱為“公地悲劇”（Hardin 1968）。

Modern medicine depends on effective antibiotics to control bacterial infections. Since the first of these wonder drugs appeared a mere 65 years ago, they have transformed the practice of medicine and saved millions of lives. But today, at the start of the 21st century, the rapid rate of emergence and spread of bacterial pathogens resistant to antibiotics threatens to return us to an era when common infections were untreatable.

The growing problem of antibiotic-resistant Staphylococcus aureus (S. aureus or “staph”) is illustrative (Figure ES.1). In

1987, 2 percent of patients infected with S. aureus failed to respond to methicillin, an inexpensive antibiotic that had been effective against these infections since the 1960s. By 2004, more than 50 percent of patients with S. aureus failed to respond to methicillin, with terrible consequences. Already a few cases of resistance to vancomycin, the drug often used to treat MRSA infections, have been reported.

Streptococcus pneumoniae (S. pneumoniae), another common pathogen, causes bacterial meningitis and bacterial

pneumonia, among other conditions. In 1987, only 2 of every 10,000 S. pneumoniae infections—0.02 percent—were resistant to penicillin, the antibiotic of choice. By 2004, this figure had risen to 1 in 5—20 percent—a 1,000-fold increase (CDC 2005).

According to the U.S. Food and Drug Administration (FDA), “Unless antibiotic resistance problems are detected as they emerge, and actions are taken to contain them, the world could be faced with previously treatable diseases that have again become untreatable, as in the days before antibiotics were developed” (Interagency Task Force on Antimicrobial

Resistance 2001). Major reports in recent years have called

for steps to address this growing threat before it engulfs the medical system (ASM 1994; OTA 1995; Harrison and Lederberg 1998), yet policymakers have taken astonishingly little action.

Antibiotic effectiveness can be thought of as a natural resource,

much like oil, fish, or forests (Laxminarayan and Brown 2001;

“The world could be faced with previously treatable diseases that have again become untreatable…”

— Interagency Task Force on Antimicrobial Resistance

Laxminarayan 2003): it is a resource accessible to anyone who

can purchase it. All antibiotic use, appropriate or not, “uses up” some of the effectiveness of that antibiotic, diminishing our ability to use it in the future. Hastening the spread of resistance by overuse of antibiotics is like other shared

resource problems, such as global warming or overfishing—a

phenomenon referred to as “the tragedy of the commons” (Hardin 1968). Approaching antibiotic resistance as a resource