通过气单胞菌的“视角”看抗微生物药物敏感性的人类健康和全球健康观点：系统评价和荟萃分析。
One Health and Global Health View of Antimicrobial Susceptibility through the "Eye" of Aeromonas: Systematic Review and Meta-Analysis.
机构信息
Department of Biomedical Sciences, University of Wisconsin - Milwaukee, Milwaukee, WI, USA.
School of Freshwater Sciences, University of Wisconsin - Milwaukee, Milwaukee, WI, USA.
出版信息
Int J Antimicrob Agents. 2023 Aug;62(2):106848. doi: 10.1016/j.ijantimicag.2023.106848. Epub 2023 May 16.
Antimicrobial resistance (AMR) is one of the most pressing public health concerns; therefore, it is imperative to advance our understanding of the factors influencing AMR from Global and One Health perspectives. To address this, Aeromonas populations were identified using 16S rRNA gene libraries among human, agriculture, aquaculture, drinking water, surface water, and wastewater samples, supporting its use as indicator bacteria to study AMR. A systematic review and meta-analysis was then performed from Global and One Health perspectives, including data from 221 articles describing 15 891 isolates from 57 countries. The interconnectedness of different environments was evident as minimal differences were identified between sectors among 21 different antimicrobials. However, resistance to critically important antibiotics (aztreonam and cefepime) was significantly higher among wastewater populations compared with clinical isolates. Additionally, isolates from untreated wastewater typically exhibited increased AMR compared with those from treated wastewater. Furthermore, aquaculture was associated with increased AMR to ciprofloxacin and tetracycline compared with wild-caught seafood. Using the World Health Organization AWaRe classifications, countries with lower consumption of "Access" compared to "Watch" drugs from 2000 to 2015 demonstrated higher AMR levels. The current analysis revealed negative correlations between AMR and anthropogenic factors, such as environmental performance indices and socioeconomic standing. Environmental health and sanitation were two of the environmental factors most strongly correlated with AMR. The current analysis highlights the negative impacts of "Watch" drug overconsumption, anthropogenic activity, absence of wastewater infrastructure, and aquaculture on AMR, thus stressing the need for proper infrastructure and global regulations to combat this growing problem.
抗微生物药物耐药性（AMR）是最紧迫的公共卫生问题之一；因此，必须从全球和同一健康的角度来提高我们对抗微生物药物耐药性影响因素的认识。为此，使用 16S rRNA 基因文库在人类、农业、水产养殖、饮用水、地表水和废水样本中鉴定气单胞菌种群，支持其作为研究抗微生物药物耐药性的指示菌。然后从全球和同一健康的角度进行了系统评价和荟萃分析，包括来自 57 个国家的 15891 个分离株的 221 篇文章的数据。不同环境之间的相互联系显而易见，因为在 21 种不同的抗生素中，不同部门之间几乎没有差异。然而，与临床分离株相比，废水种群对抗重要抗生素（氨曲南和头孢吡肟）的耐药性明显更高。此外，与来自处理过的废水的分离株相比，未经处理的废水中的分离株通常表现出更高的 AMR。此外，与野生捕捞的海鲜相比，水产养殖与环丙沙星和四环素的 AMR 增加有关。使用世界卫生组织 AWaRe 分类，与 2000 年至 2015 年期间“关注”类药物相比，“准入”类药物消耗较低的国家表现出更高的 AMR 水平。目前的分析显示，抗微生物药物耐药性与人为因素之间存在负相关，如环境绩效指数和社会经济地位。环境卫生和卫生设施是与抗微生物药物耐药性相关性最强的两个环境因素。目前的分析强调了“关注”类药物过度消耗、人为活动、缺乏废水基础设施和水产养殖对抗微生物药物耐药性的负面影响，因此强调需要适当的基础设施和全球法规来应对这一日益严重的问题。
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