近年来随着碳青霉烯耐药肠杆菌科细菌（CRE）流行率的不断增加，以及携带新型可转移多粘菌素耐药基因mcr-1肠杆菌科细菌（MCRPE）的发现，泛耐药肠杆菌科细菌（XDRE）成为了我国医学临床治疗和畜禽健康养殖的巨大负担。本项目拟以CRE和MCRPE为代表，研究XDRE在我国临床、社区、动物、食品和环境中的流行特征、耐药产生和传播机制，根据上述结果采用数学模型预测XDRE在医学临床和畜禽养殖的传播趋势、经济负担和治疗成本。.计划采集分析：1. 社区保健和医院临床样本+调查问卷；2. 健康人群粪便样本+调查问卷；3. 动物性食品；4. 屠宰场；5. 养殖场； 6. 环境样品。收集至少17280份样品，对约2000~2400株XDRE进行测序。根据流行病学数据建立XDRE传播的数学模型，并评估替代方式（如中药）治疗XDRE。

The burden of extensively drug resistant Enterobacteriaceae (XDRE) in China has never been greater as evidenced by the recent discovery of MCR-1 and the increasing prevalence of Carbapenem Resistance Enterobacteriaceae (CRE). In 2015 we formed a network that blended clinical and veterinary XDR data that led to the first report of MCR-1. Using CRE and MCR-1 as an exemplar of XDR, we now propose and undertake a comprehensive analysis of XDR in China, and using these data, apply mathematical models to predict the future impact, burden and cost of XDR..We will analyses the following samples: 1. Primary and Secondary care clinical samples supported by detailed questionnaires facilitating univariant and multivariant outcomes and predictors. 2. Normal human flora (faecal carriage of XDRE) supported by questionnaires on lifestyles. 3. Retail meat (pork and chicken) 4. Slaughter houses (faecal carriage of XDRE). 5. Chickens (hatcheries and farms) and pork farms. 6. Environment (wild birds and flies etc.). We will collect at least 17280 samples and sequence 2000-2400 Enterobacteriaceae. Additionally, we will use farms to mathematically model the spread of XDRE and examine alternative therapies such as traditional Chinese medicines.