Environment Agency, Horizon House, Deanery Road, Bristol, United Kingdom.
Euro Surveill. 2023 Mar;28(11). doi: 10.2807/1560-7917.ES.2023.28.11.2200367.
The development, and in some cases increasing prevalence, of resistance to antimicrobials used in clinical and veterinary settings has long been recognised. In recent years, the concept of 'One Health' has added recognition of the role that the environment plays in health protection along with the need for protection of the health of the environment itself. Organisations including the World Health Organization, United Nations Environment Programme, and national governments have identified a need for surveillance of antimicrobial resistance in the environment to sit alongside the surveillance carried out in clinical, veterinary and food sectors. However, having recognised the need for environmental surveillance there are multiple challenges in deciding what this should entail. For example, what pathogens or genes to monitor, who or what we wish to protect and what measures we wish to enable to decrease infection risks. That might include sampling near a source of resistant organisms entering the environment or conversely sampling where the exposure actually occurs. Choices need to be made at both policy and technical levels based on the detailed purposes of surveillance. This paper discusses these issues from the perspective of a national environmental regulator.
长期以来，人们一直认识到临床和兽医环境中使用的抗菌药物的耐药性的发展，而且在某些情况下耐药性还在不断增加。近年来，“同一健康”的概念不仅认识到环境在保护健康方面的作用，还需要保护环境本身的健康。世界卫生组织、联合国环境规划署和各国政府等组织已经认识到，需要对环境中的抗微生物药物耐药性进行监测，这与在临床、兽医和食品部门进行的监测相配合。然而，在认识到需要进行环境监测的同时，在决定应该包含哪些内容方面存在诸多挑战。例如，要监测哪些病原体或基因，我们希望保护谁或什么，以及我们希望采取哪些措施来降低感染风险。这可能包括在耐药生物体进入环境的源头附近取样，或者相反地在实际暴露的地方取样。需要根据监测的具体目的在政策和技术层面做出选择。本文从国家环境监管者的角度讨论了这些问题。
