European Centre for Environment and Human Health, University of Exeter Medical School, Knowledge Spa, Royal Cornwall Hospital, Truro, Cornwall TR1 3HD, UK.
European Centre for Environment and Human Health, University of Exeter Medical School, Knowledge Spa, Royal Cornwall Hospital, Truro, Cornwall TR1 3HD, UK.
Environ Int. 2015 Sep;82:92-100. doi: 10.1016/j.envint.2015.02.013. Epub 2015 Mar 30.
Infections caused by antibiotic resistant bacteria (ARB) are associated with poor health outcomes and are recognised globally as a serious health problem. Much research has been conducted on the transmission of ARB to humans. Yet the role the natural environment plays in the spread of ARB and antibiotic resistance genes is not well understood. Antibiotic resistant bacteria have been detected in natural aquatic environments, and ingestion of seawater during water sports is one route by which many people could be directly exposed. The aim was to estimate the prevalence of resistance to one clinically important class of antibiotics (third-generation cephalosporins (3GCs)) amongst Escherichia coli in coastal surface waters in England and Wales. Prevalence data was used to quantify ingestion of 3GC-resistant E. coli (3GCREC) by people participating in water sports in designated coastal bathing waters. A further aim was to use this value to derive a population-level estimate of exposure to these bacteria during recreational use of coastal waters in 2012. The prevalence of 3GC-resistance amongst E. coli isolated from coastal surface waters was estimated using culture-based methods. This was combined with the density of E. coli reported in designated coastal bathing waters along with estimations of the volumes of water ingested during various water sports reported in the literature to calculate the mean number of 3GCREC ingested during different water sports. 0.12% of E. coli isolated from surface waters were resistant to 3GCs. This value was used to estimate that in England and Wales over 6.3 million water sport sessions occurred in 2012 that resulted in the ingestion of at least one 3GCREC. Despite the low prevalence of resistance to 3GCs amongst E. coli in surface waters, there is an identifiable human exposure risk for water users, which varies with the type of water sport undertaken. The relative importance of this exposure is likely to be greater in areas where a large proportion of the population enjoys water sports. Millions of water sport sessions occurred in 2012 that were likely to have resulted in people ingesting E. coli resistant to a single class of antibiotics (3GCs). However, this is expected to be a significant underestimate of recreational exposure to all ARB in seawater. This is the first study to use volumes of water ingested during different water sports to estimate human exposure to ARB. Further work needs to be done to elucidate the health implications and clinical relevance of exposure to ARB in both marine and fresh waters in order to fully understand the risk to public health.
抗生素耐药细菌（ARB）引起的感染与健康状况不佳有关，已在全球范围内被认为是一个严重的健康问题。已经有很多关于 ARB 传播给人类的研究。然而，自然环境在 ARB 和抗生素耐药基因传播中的作用还没有得到很好的理解。在自然水生环境中已经检测到了抗生素耐药细菌，而在水上运动中摄入海水是许多人直接暴露的途径之一。本研究旨在估计英格兰和威尔士沿海地表水大肠杆菌对一类临床重要抗生素（第三代头孢菌素（3GCs））的耐药率。耐药率数据用于量化参与指定沿海浴场水运动的人群摄入 3GC 耐药大肠杆菌（3GCREC）的情况。另一个目的是利用 2012 年沿海地区休闲用水人群中暴露于这些细菌的这一数值来得出人群水平的估计值。使用基于培养的方法估计从沿海地表水分离出的大肠杆菌对 3GC 的耐药率。将这一数值与指定沿海浴场报告的大肠杆菌密度以及文献中报告的各种水上运动中摄入的水量估计值相结合，计算出不同水上运动中摄入的 3GCREC 的平均数量。从地表水分离出的大肠杆菌中有 0.12%对 3GC 耐药。利用这一数值估计 2012 年在英格兰和威尔士进行了超过 630 万次水运动，导致至少摄入了一个 3GCREC。尽管地表水大肠杆菌对 3GC 的耐药率较低，但对水使用者来说存在可识别的人类暴露风险，这种风险因所进行的水上运动类型而异。在大量人口享受水上运动的地区，这种暴露的相对重要性可能更大。2012 年进行了数百万次水运动，可能导致人们摄入对单一抗生素类（3GCs）耐药的大肠杆菌。然而，这预计是对海水中所有 ARB 休闲暴露的一个显著低估。这是第一项使用不同水上运动中摄入的水量来估计人类接触 ARB 的研究。需要进一步研究以阐明在海洋和淡水中接触 ARB 的健康影响和临床相关性，以便充分了解对公众健康的风险。
