School of Biosystems and Food Engineering, University College Dublin, Dublin, Ireland.
Galway School of Medicine, National University of Ireland, Galway, Ireland.
J Environ Sci Health A Tox Hazard Subst Environ Eng. 2021;56(7):733-751. doi: 10.1080/10934529.2021.1923311. Epub 2021 May 12.
Antimicrobial resistance is a major concern for human and animal health, projected to deteriorate with time and given current trends of antimicrobial usage. Antimicrobial use, particularly in healthcare and agriculture, can result in the release of antimicrobials into surface waters, promoting the development of antibiotic resistance in the environment, and potentially leading to human health risks. This study reviews relevant literature, and investigates current European and Irish antimicrobial usage trends in humans and animals, as well as potential pathways that antibiotics can take into surface waters following use. Reported levels in the aquatic environment are summarized, with particular focus on Ireland. There are relatively few studies examining Irish water bodies or sewage effluent for antibiotic residues, however, five antibiotics, namely azithromycin, ciprofloxacin, clarithromycin, metronidazole, and trimethoprim, have been measured in Irish waters, in concentrations predicted to select for resistance. Numerous isolates of multi-drug resistant bacteria have also been found in water bodies throughout Ireland and Europe. The value of risk assessment methodologies in understanding risks posed by antibiotic residues is reviewed including the advantages and disadvantages of specific approaches. Hazard quotient and bespoke Monte Carlo approaches are predominant risk assessment tools used to examine antimicrobial release and their complex pathways. This study highlights the need for monitoring of antimicrobial releases and the potential for resistance development, persistence and transmission while highlighting the role of risk assessment methodologies in assessing potential human and environmental health impacts.
抗微生物药物耐药性是人类和动物健康的主要关注点，预计随着时间的推移和当前抗微生物药物使用趋势的恶化而恶化。抗微生物药物的使用，特别是在医疗保健和农业领域，可能导致抗微生物药物释放到地表水中，促进环境中抗生素耐药性的发展，并可能对人类健康造成风险。本研究综述了相关文献，并调查了当前欧洲和爱尔兰在人类和动物中抗微生物药物使用的趋势，以及抗生素在使用后进入地表水的潜在途径。总结了报告的水生环境中的水平，特别关注爱尔兰。尽管有相对较少的研究检查爱尔兰水体或污水中的抗生素残留，但已经在爱尔兰水中测量了五种抗生素，即阿奇霉素、环丙沙星、克拉霉素、甲硝唑和甲氧苄啶，其浓度预计会选择耐药性。在爱尔兰和欧洲的水体中也发现了许多多药耐药细菌的分离株。本文回顾了风险评估方法在理解抗生素残留带来的风险方面的价值，包括特定方法的优缺点。危害商数和定制的蒙特卡罗方法是用于检查抗微生物药物释放及其复杂途径的主要风险评估工具。本研究强调了需要监测抗微生物药物的释放以及耐药性的发展、持久性和传播的潜力，同时强调了风险评估方法在评估潜在的人类和环境健康影响方面的作用。
