College of Public Health, Division of Environmental Health Sciences, The Ohio State University, Columbus, OH, United States; Environmental Sciences Graduate Program, The Ohio State University, Columbus, OH, United States.
College of Public Health, Division of Environmental Health Sciences, The Ohio State University, Columbus, OH, United States; Environmental Sciences Graduate Program, The Ohio State University, Columbus, OH, United States; Department of Food Science & Technology, The Ohio State University, Columbus, OH, United States.
Environ Pollut. 2019 Dec;255(Pt 1):113143. doi: 10.1016/j.envpol.2019.113143. Epub 2019 Sep 9.
Environmental reservoirs of antibiotic resistance (AR) are a growing concern that are gathering more attention as potential sources for human infection. Carbapenem-resistant Enterobacteriaceae (CRE) are extremely dangerous, as carbapenems are often drugs of last resort that are used to treat multi-drug resistant infections. Among the genes capable of conferring carbapenem resistance to bacteria, the most transferrable are those that produce carbapenemase, an enzyme that hydrolyzes carbapenems and other β-lactam antibiotics. The goal of this review was to comprehensively identify global environmental reservoirs of carbapenemase-producing genes, as well as identify potential routes of transmission to humans. The genes of interest were Klebsiella pneumoniae carbapenemase (KPC), New Delhi Metallo-β-lactamase (NDM), Oxacillinase-48-type carbapenemases (OXA-48), and Verona Integron-Mediated Metallo-β-lactamase (VIM). Carbapenemase genes have been reported in the environment on almost every continent. Hospital and municipal wastewater, drinking water, natural waterways, sediments, recreational waters, companion animals, wildlife, agricultural environments, food animals, and retail food products were identified as current reservoirs of carbapenemase-producing bacteria and genes. Humans have been recorded as carrying CRE, without recent admittance to a hospital or long-term care facility in France, Egypt, and China. CRE infections from the environment have been reported in patients in Montpellier, France and Cairo, Egypt. This review demonstrates the need for 1) comprehensive monitoring of AR not only in waterways, but also other types of environmental matrices, such as aerosol, dusts, periphyton, and surfaces in indoor environments; and 2) action to reduce the prevalence and mitigate the effects of these potentially deadly resistance genes. In order to develop an accurate quantitative model for environmental dimensions of AR, longitudinal sampling and quantification of AR genes and bacteria are needed, using a One Health approach.
环境中的抗生素耐药性（AR）是一个日益严重的问题，越来越受到关注，因为它们可能成为人类感染的潜在来源。耐碳青霉烯肠杆菌科（CRE）是极其危险的，因为碳青霉烯类药物通常是用于治疗多重耐药感染的最后手段。在能够赋予细菌碳青霉烯耐药性的基因中，最具可转移性的是那些产生碳青霉烯酶的基因，这种酶可以水解碳青霉烯类和其他β-内酰胺类抗生素。本综述的目的是全面识别全球产生碳青霉烯酶基因的环境储库，并确定向人类传播的潜在途径。感兴趣的基因包括肺炎克雷伯菌碳青霉烯酶（KPC）、新德里金属β-内酰胺酶（NDM）、OXA-48 型β-内酰胺酶和 Verona 整合子介导的金属β-内酰胺酶（VIM）。碳青霉烯酶基因几乎在各大洲的环境中都有报道。医院和市政废水、饮用水、天然水道、沉积物、娱乐水、伴侣动物、野生动物、农业环境、食用动物和零售食品被认为是产碳青霉烯酶细菌和基因的当前储库。在法国、埃及和中国，CRE 感染患者在没有最近住院或长期护理的情况下被记录携带 CRE。在法国蒙彼利埃和埃及开罗，已有患者报告从环境中感染 CRE。本综述表明需要：1）不仅在水道，而且在其他类型的环境基质（如气溶胶、灰尘、周丛生物和室内环境表面）中，对 AR 进行全面监测；2）采取行动降低这些潜在致命耐药基因的流行率并减轻其影响。为了开发 AR 环境维度的准确定量模型，需要使用 One Health 方法进行纵向采样和定量检测 AR 基因和细菌。
