[Debate on impact of restriction on antimicrobial use on antimicrobial resistance rate: explanation and deliberation]

Antimicrobial resistance (AMR) is a rising public health crisis worldwide. Antimicrobial stewardship, which core is restriction on antimicrobial use to decline selective pressure of AMR, becomes main strategy for tackling AMR. But there are lots of debates about beneficial impact of restriction to antimicrobial use on AMR in recent years. One of the important reasons of the debate is defects on research methodology, especially there are no differentiation between hospital antibiogram and surveillance antibiogram, because the former is used as a reference of empirical antibiotic therapy, and only the latter is appropriate for evaluating factors affecting resistance, including antibiotic use. Once bacteria develop drug resistance, there are both the fitness costs resulting its loss of competitiveness in evolution and restoration of sensitivity to antibiotics, and mechanism of compensatory evolution which allows AMR to persist in bacteria. It is suggested that only by deeply studying the molecular genetics and evolutionary mechanism of drug-resistant bacteria can we find the fundamental way to overcome AMR. At present, we need to adhere to and improve the antimicrobial stewardship, develop new anti-bacterial agents and therapies, connect the Healthy China strategy with the great health concept advocated by WHO and other international organizations, learn from international experience to curb AMR, and promote coordinated and sustainable economic and social development.