Division of Systems and Synthetic Biology, Department of Life Sciences, SciLifeLab, Chalmers University of Technology, SE-412 96 Gothenburg, Sweden; Department of Infectious Diseases, Institute of Biomedicine, The Sahlgrenska Academy, University of Gothenburg, Guldhedsgatan 10, SE-413 46 Gothenburg, Sweden; Centre for Antibiotic Resistance Research (CARe) in Gothenburg, Sweden.
Division of Systems and Synthetic Biology, Department of Life Sciences, SciLifeLab, Chalmers University of Technology, SE-412 96 Gothenburg, Sweden; Department of Infectious Diseases, Institute of Biomedicine, The Sahlgrenska Academy, University of Gothenburg, Guldhedsgatan 10, SE-413 46 Gothenburg, Sweden; Centre for Antibiotic Resistance Research (CARe) in Gothenburg, Sweden.
Environ Int. 2023 Aug;178:108089. doi: 10.1016/j.envint.2023.108089. Epub 2023 Jul 5.
Antimicrobial resistance (AMR) is a global threat to human and animal health and well-being. To understand AMR dynamics, it is important to monitor resistant bacteria and resistance genes in all relevant settings. However, while monitoring of AMR has been implemented in clinical and veterinary settings, comprehensive monitoring of AMR in the environment is almost completely lacking. Yet, the environmental dimension of AMR is critical for understanding the dissemination routes and selection of resistant microorganisms, as well as the human health risks related to environmental AMR. Here, we outline important knowledge gaps that impede implementation of environmental AMR monitoring. These include lack of knowledge of the 'normal' background levels of environmental AMR, definition of high-risk environments for transmission, and a poor understanding of the concentrations of antibiotics and other chemical agents that promote resistance selection. Furthermore, there is a lack of methods to detect resistance genes that are not already circulating among pathogens. We conclude that these knowledge gaps need to be addressed before routine monitoring for AMR in the environment can be implemented on a large scale. Yet, AMR monitoring data bridging different sectors is needed in order to fill these knowledge gaps, which means that some level of national, regional and global AMR surveillance in the environment must happen even without all scientific questions answered. With the possibilities opened up by rapidly advancing technologies, it is time to fill these knowledge gaps. Doing so will allow for specific actions against environmental AMR development and spread to pathogens and thereby safeguard the health and wellbeing of humans and animals.
抗微生物药物耐药性（AMR）是对人类和动物健康与福祉的全球性威胁。为了了解 AMR 的动态，监测所有相关环境中的耐药细菌和耐药基因非常重要。然而，虽然已经在临床和兽医环境中实施了 AMR 监测，但对环境中 AMR 的全面监测几乎完全缺乏。然而，AMR 的环境层面对于了解耐药微生物的传播途径和选择以及与环境 AMR 相关的人类健康风险至关重要。在这里，我们概述了阻碍环境 AMR 监测实施的重要知识差距。这些差距包括缺乏对环境 AMR“正常”背景水平的了解、确定具有传播风险的高风险环境、以及对促进耐药性选择的抗生素和其他化学剂浓度的了解不足。此外，缺乏检测尚未在病原体中循环的耐药基因的方法。我们的结论是，在大规模实施环境中 AMR 的常规监测之前，需要解决这些知识差距。然而，需要不同部门之间的 AMR 监测数据来填补这些知识空白，这意味着即使没有回答所有科学问题，也必须在环境中进行一定程度的国家、地区和全球 AMR 监测。随着快速发展的技术提供的可能性，现在是填补这些知识空白的时候了。这样做将能够针对环境 AMR 的发展和传播到病原体采取具体行动，从而保障人类和动物的健康和福祉。
