Hanna Nada, Tamhankar Ashok J, Stålsby Lundborg Cecilia
Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.
Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden; Indian Initiative for Management of Antibiotic Resistance, Department of Environmental Medicine, RD Gardi Medical College, Ujjain, India.
Lancet Planet Health. 2023 Jan;7(1):e45-e54. doi: 10.1016/S2542-5196(22)00254-6.
Antibiotic resistance poses human health risks, and there are concerns about the effect of environmental antibiotic residues in the selection and spread of antibiotic resistance. The aim of this study was to identify antibiotic residue levels that are likely to select for resistance and relative contributions from different aquatic sources, of various aquatic environmental compartments of the WHO Western Pacific region (WPR) and the WHO South-East Asia region (SEAR), including in China and India.
A systematic review of empirical studies that measured antibiotic concentrations in aquatic environments, published between 2006 and 2019, and a probabilistic environmental hazard assessments approach, were used to identify antibiotic concentrations that are likely to select for resistance in various aquatic environmental compartments of the WPR and SEAR, including in China and India. The assessment involved the use of measured environmental concentrations and predicted no-effect concentrations (PNECs).
The systematic review found 218 relevant studies of 5230 screened from the WPR and 22 relevant studies of 2625 screened from the SEAR; some of these relevant studies were largely from China (n=168) and India (n=15). 92 antibiotics in the WPR and 45 in the SEAR were detected in various aquatic compartments. Antibiotic concentrations that most likely exceeded PNECs (0-100%) were observed in wastewater, and influents and effluents of wastewater treatment plants. Antibiotic concentrations that most likely exceeded PNECs were also observed in aquatic environmental compartments. The highest risk for the development of resistance was in tap or drinking water of the WPR and China for ciprofloxacin (62·5%). The relative contributions of potential sources of antibiotic contamination in waterways, such as hospitals, municipals, livestock, and pharmaceutical manufacturing, was determined for each antibiotic.
The concentrations of antibiotic residues found in wastewater and wastewater treatment plants of the WPR and SEAR make them potential hotspots for the development of antibiotic resistance, which creates human health risks from environmental exposure via drinking water. These findings can help decision makers to target risk reduction measures against environmental residues of priority antibiotics in high-risk sites, and help to focus research efforts in these world regions.
Swedish Research Council.
抗生素耐药性对人类健康构成风险，人们担心环境中的抗生素残留对耐药性的选择和传播产生影响。本研究旨在确定世界卫生组织西太平洋区域（WPR）和东南亚区域（SEAR）（包括中国和印度）不同水生来源以及各种水生环境隔室中可能选择耐药性的抗生素残留水平和相对贡献。
对2006年至2019年间发表的测量水生环境中抗生素浓度的实证研究进行系统综述，并采用概率性环境危害评估方法，以确定WPR和SEAR（包括中国和印度）各种水生环境隔室中可能选择耐药性的抗生素浓度。该评估涉及使用测量的环境浓度和预测无效应浓度（PNECs）。
系统综述在从WPR筛选的5230项研究中发现了218项相关研究，在从SEAR筛选的2625项研究中发现了22项相关研究；其中一些相关研究主要来自中国（n = 168）和印度（n = 15）。在各种水生隔室中检测到WPR中的92种抗生素和SEAR中的45种抗生素。在废水以及污水处理厂的进水和出水中观察到最有可能超过PNECs（0 - 100%）的抗生素浓度。在水生环境隔室中也观察到最有可能超过PNECs的抗生素浓度。WPR和中国的自来水或饮用水中，环丙沙星产生耐药性的风险最高（62.5%）。确定了每条水道中抗生素污染潜在来源（如医院、市政、畜牧业和制药制造业）对每种抗生素的相对贡献。
在WPR和SEAR的废水及污水处理厂中发现的抗生素残留浓度使其成为抗生素耐药性发展的潜在热点，这通过饮用水造成环境暴露带来人类健康风险。这些发现可帮助决策者针对高风险地点优先抗生素的环境残留制定降低风险措施，并有助于集中这些世界区域的研究工作。
瑞典研究委员会
