Department of Frontier Sciences for Advanced Environment, Graduate School of Environmental Studies, Tohoku University, Sendai 980-8579, Japan and Department of Civil and Environmental Engineering, Graduate School of Engineering, Tohoku University, Sendai 980-8579, Japan E-mail:
Center for Antimicrobial Resistance, Norwegian Institute of Public Health, Oslo, Norway.
J Water Health. 2020 Dec;18(6):858-866. doi: 10.2166/wh.2020.033.
The emergence and spread of antimicrobial resistance (AMR), including clinically relevant antimicrobial-resistant bacteria, genetic resistance elements, and antibiotic residues, presents a significant threat to human health. Reducing the incidence of infection by improving water, sanitation, and hygiene (WASH) is one of five objectives in the World Health Organization's (WHO) Global Action Plan on AMR. In September 2019, WHO and the Health-Related Water Microbiology specialist group (HRWM-SG) of the International Water Association (IWA) organized its third workshop on AMR, focusing on the following three main issues: environmental pathways of AMR transmission, environmental surveillance, and removal from human waste. The workshop concluded that despite an increase in scientific evidence that the environment may play a significant role, especially in low-resource settings, the exact relative role of the environment is still unclear. Given many antibiotic-resistant bacteria (ARB) can be part of the normal gut flora, it can be assumed that for environmental transmission, the burden of fecal-oral transmission of AMR in a geographical area follows that of WASH-related infections. There are some uncertainties as to the potential for the propagation of particular resistance genes within wastewater treatment plants (WWTPs), but there is no doubt that the reduction in viable microbes (with or without resistance genes) available for transmission via the environment is one of the goals of human waste management. Although progress has been made in the past years with respect to quantifying environmental AMR transmission potential, still more data on the spread of environmental AMR within human communities is needed. Even though evidence on AMR in WWTPs has increased, the reduction in the emergence and spread of AMR by basic sanitation methods is yet unresolved. In order to contribute to the generation of harmonized One Health surveillance data, WHO has initiated an integrated One Health surveillance strategy that includes the environment. The main challenge lies in rolling it out globally including to the poorest regions.
抗菌药物耐药性（AMR）的出现和传播，包括具有临床相关性的抗菌药物耐药菌、遗传耐药元件和抗生素残留，对人类健康构成重大威胁。通过改善水、环境卫生和个人卫生（WASH）来减少感染的发生，是世界卫生组织（WHO）抗菌药物耐药性全球行动计划的五个目标之一。2019 年 9 月，世卫组织和国际水协会（IWA）与水相关的微生物专家组（HRWM-SG）联合举办了第三次 AMR 专题研讨会，重点讨论了以下三个主要问题：AMR 的环境传播途径、环境监测以及从人类粪便中去除。会议得出结论，尽管越来越多的科学证据表明，环境可能特别是在资源匮乏环境中，发挥着重要作用，但环境的确切相对作用仍不清楚。鉴于许多抗生素耐药菌（ARB）可能是正常肠道菌群的一部分，可以假设，在特定地理区域，环境传播的 AMR 粪-口传播负担与 WASH 相关感染的传播负担一致。对于特定抗性基因在废水处理厂（WWTP）内的传播潜力存在一些不确定性，但毫无疑问，减少通过环境传播的可用微生物（无论是否具有抗性基因）的数量，是人类粪便管理的目标之一。尽管过去几年在量化环境 AMR 传播潜力方面取得了一些进展，但仍需要更多关于人类社区内环境 AMR 传播的数据。尽管 WWTP 中的 AMR 证据有所增加，但基本卫生方法在减少 AMR 的出现和传播方面仍未得到解决。为了有助于生成协调一致的“同一健康”监测数据，世卫组织已启动了一项包含环境内容的“同一健康”综合监测战略。主要挑战在于在全球范围内实施这一战略，包括最贫困地区。
