Laboratory of Molecular Environmental Microbiology, Department of Environmental Science and Ecological Engineering, Korea University, Seoul, 02841, Republic of Korea.
J Microbiol. 2021 Jun;59(6):535-545. doi: 10.1007/s12275-021-1085-9. Epub 2021 Apr 20.
The emergence of multidrug resistance (MDR) has become a global health threat due to the increasing unnecessary use of antibiotics. Multidrug resistant bacteria occur mainly by accumulating resistance genes on mobile genetic elements (MGEs), made possible by horizontal gene transfer (HGT). Humans and animal guts along with natural and engineered environments such as wastewater treatment plants and manured soils have proven to be the major reservoirs and hotspots of spreading antibiotic resistance genes (ARGs). As those environments support the dissemination of MGEs through the complex interactions that take place at the human-animal-environment interfaces, a growing One Health challenge is for multiple sectors to communicate and work together to prevent the emergence and spread of MDR bacteria. However, maintenance of ARGs in a bacterial chromosome and/or plasmids in the environments might place energy burdens on bacterial fitness in the absence of antibiotics, and those unnecessary ARGs could eventually be lost. This review highlights and summarizes the current investigations into the gain and loss of ARG genes in MDR bacteria among human-animal-environment interfaces. We also suggest alternative treatments such as combinatory therapies or sequential use of different classes of antibiotics/adjuvants, treatment with enzyme-inhibitors, and phage therapy with antibiotics to solve the MDR problem from the perspective of One Health issues.
多药耐药性（MDR）的出现是一个全球性的健康威胁，因为抗生素的不合理使用越来越多。多药耐药菌主要通过在移动遗传元件（MGE）上积累耐药基因而产生，这得益于水平基因转移（HGT）。人类和动物肠道以及废水处理厂和施肥土壤等自然和工程环境已被证明是传播抗生素耐药基因（ARGs）的主要储存库和热点。由于这些环境通过在人类-动物-环境界面上发生的复杂相互作用支持 MGE 的传播，一个日益增长的“同一健康”挑战是多个部门进行沟通和合作，以防止 MDR 细菌的出现和传播。然而，在没有抗生素的情况下，细菌染色体和/或质粒中 ARGs 的维持会给细菌适应性带来能量负担，那些不必要的 ARGs 最终可能会丢失。这篇综述强调并总结了目前在人类-动物-环境界面中对多药耐药菌中 ARG 基因的获得和丢失的研究。我们还从“同一健康”问题的角度提出了替代治疗方法，如联合治疗或不同类别的抗生素/佐剂的序贯使用、酶抑制剂治疗以及噬菌体治疗与抗生素联合使用，以解决 MDR 问题。
