Department of Civil and Environmental Engineering, University of California, Berkeley, CA, USA; Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle, WA, USA.
Department of Civil and Environmental Engineering, University of California, Berkeley, CA, USA.
Lancet Microbe. 2023 Aug;4(8):e591-e600. doi: 10.1016/S2666-5247(23)00137-4. Epub 2023 Jun 30.
Antibiotic resistance is a leading cause of death, with the highest burden occurring in low-resource settings. There is little evidence on the potential for water, sanitation, and hygiene (WASH) access to reduce antibiotic resistance in humans. We aimed to determine the relationship between the burden of antibiotic resistance in humans and community access to drinking water and sanitation.
In this ecological study, we linked publicly available, geospatially tagged human faecal metagenomes (from the US National Center for Biotechnology Information Sequence Read Archive) with georeferenced household survey datasets that reported access to drinking water sources and sanitation facility types. We used generalised linear models with robust SEs to estimate the relationship between the abundance of antibiotic resistance genes (ARGs) in human faecal metagenomes and community-level coverage of improved drinking water and sanitation within a defined radii of faecal metagenome coordinates.
We identified 1589 metagenomes from 26 countries. The mean abundance of ARGs, in units of log ARG fragments per kilobase per million mapped reads classified as bacteria, was highest in Africa compared with Europe (p=0·014), North America (p=0·0032), and the Western Pacific (p=0·011), and second highest in South-East Asia compared with Europe (p=0·047) and North America (p=0·014). Increased access to improved water and sanitation was associated with lower ARG abundance (effect estimate -0·22, [95% CI -0·39 to -0·05]) and the association was stronger in urban (-0·32 [-0·63 to 0·00]) than in rural (-0·16 [-0·38 to 0·07]) areas.
Although additional studies to investigate causal effects are needed, increasing access to water and sanitation could be an effective strategy to curb the proliferation of antibiotic resistance in low-income and middle-income countries.
Bill & Melinda Gates Foundation.
抗生素耐药性是导致死亡的主要原因，而资源匮乏地区的负担最重。关于获得水、环境卫生和个人卫生（WASH）是否有助于减少人类对抗生素耐药性的证据很少。我们旨在确定人类对抗生素耐药性的负担与社区获得饮用水和卫生设施之间的关系。
在这项生态研究中，我们将公开提供的、具有地理标记的人类粪便宏基因组（来自美国国家生物技术信息中心序列读取档案）与具有饮用水源和卫生设施类型的家庭调查数据集相联系。我们使用广义线性模型和稳健标准误差来估计人类粪便宏基因组中抗生素耐药基因（ARGs）的丰度与粪便宏基因组坐标定义的半径内社区改善饮用水和卫生设施的覆盖范围之间的关系。
我们从 26 个国家确定了 1589 个宏基因组。以每百万映射读数分类为细菌的每千碱基对数的抗生素耐药基因片段单位表示的 ARG 丰度，在非洲最高，与欧洲（p=0·014）、北美（p=0·0032）和西太平洋（p=0·011）相比，在非洲最高，与欧洲（p=0·047）和北美（p=0·014）相比，在东南亚排名第二。增加获得改良水和卫生设施与较低的 ARG 丰度相关（效应估计值-0·22，[95%CI-0·39 至-0·05]），在城市地区（-0·32 [-0·63 至 0·00]）比在农村地区（-0·16 [-0·38 至 0·07]）更强。
尽管需要进一步研究以调查因果关系，但增加获得水和卫生设施的机会可能是遏制低收入和中等收入国家抗生素耐药性扩散的有效策略。
比尔和梅琳达盖茨基金会。
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