薬剤耐性の世界的疫学：動向、決定要因、公衆衛生への影響

Antimicrobial resistance (AMR) represents one of the most pressing global health and development challenges of the twenty-first century, threatening the effectiveness of antimicrobial therapies and undermining the clinical management of infectious diseases worldwide. The increasing prevalence of resistant pathogens undermines progress in disease control, surgery, and critical care, and poses severe socioeconomic and public health consequences. This narrative review synthesizes multidisciplinary evidence to examine the global trends, determinants, and implications of AMR through an integrated One Health framework encompassing human, animal, and environmental systems. The review draws upon peer-reviewed literature, international surveillance data, and policy reports published between 2015 and 2025 to provide a comprehensive understanding of resistance patterns and drivers. Findings reveal that resistance arises from an interplay of inappropriate antimicrobial use, insufficient infection prevention, environmental contamination, and weak governance, with the heaviest burden in low- and middle-income countries. Despite global action plans and stewardship initiatives, progress remains constrained by inequitable resources, limited diagnostics, and fragmented implementation. Strengthening surveillance systems, fostering responsible antimicrobial use, promoting research and vaccine development, and embedding One Health principles in policy are vital to reversing current trends. Coordinated global action, equitable investment, and sustained political commitment are essential to preserve antimicrobial efficacy and ensure the resilience of health systems worldwide.