Expert Microbiology Unit, Finnish Institute for Health and Welfare, 70701, Kuopio, Finland.
Norwegian Research Centre AS (NORCE), Nygårdstangen, 5838, Bergen, Norway.
Environ Res. 2024 Apr 1;246:118052. doi: 10.1016/j.envres.2023.118052. Epub 2023 Dec 30.
The Nordic countries (Denmark, Finland, Iceland, Norway, and Sweden) have effectively kept lower antibiotic-resistant bacterial (ARB) pathogen rates than many other countries. However, in recent years, these five countries have encountered a rise in ARB cases and challenges in treating infections due to the growing prevalence of ARB pathogens. Wastewater-based surveillance (WBS) is a valuable supplement to clinical methods for ARB surveillance, but there is a lack of comprehensive understanding of WBS application for ARB in the Nordic countries. This review aims to compile the latest state-of-the-art developments in WBS for ARB monitoring in the Nordic countries and compare them with clinical surveillance practices. After reviewing 1480 papers from the primary search, 54 were found relevant, and 15 additional WBS-related papers were included. Among 69 studies analyzed, 42 dedicated clinical epidemiology, while 27 focused on wastewater monitoring. The PRISMA review of the literature revealed that Nordic countries focus on four major WBS objectives of ARB: assessing ARB in the human population, identifying ARB evading wastewater treatment, quantifying removal rates, and evaluating potential ARB evolution during the treatment process. In both clinical and wastewater contexts, the most studied targets were pathogens producing carbapenemase and extended-spectrum beta-lactamase (ESBL), primarily Escherichia coli and Klebsiella spp. However, vancomycin-resistant Enterococcus (VRE) and methicillin-resistant Staphylococcus aureus (MRSA) have received more attention in clinical epidemiology than in wastewater studies, probably due to their lower detection rates in wastewater. Clinical surveillance has mostly used culturing, antibiotic susceptibility testing, and genotyping, but WBS employed PCR-based and metagenomics alongside culture-based techniques. Imported cases resulting from international travel and hospitalization abroad appear to have frequently contributed to the rise in ARB pathogen cases in these countries. The many similarities between the Nordic countries (e.g., knowledge exchange practices, antibiotic usage patterns, and the current ARB landscape) could facilitate collaborative efforts in developing and implementing WBS for ARB in population-level screening.
北欧国家(丹麦、芬兰、冰岛、挪威和瑞典)在控制抗生素耐药菌(ARB)病原体方面的效果优于许多其他国家。然而,近年来,由于 ARB 病原体的流行率不断上升,这些国家面临着 ARB 病例的增加和感染治疗的挑战。基于污水的监测(WBS)是 ARB 监测的临床方法的有益补充,但北欧国家对 WBS 在 ARB 中的应用缺乏全面了解。本综述旨在汇编北欧国家用于监测 ARB 的 WBS 的最新技术发展,并将其与临床监测实践进行比较。在对初步搜索的 1480 篇论文进行审查后,发现 54 篇相关论文,并纳入了另外 15 篇与 WBS 相关的论文。在分析的 69 项研究中,42 项专注于临床流行病学,27 项专注于污水监测。文献的 PRISMA 审查表明,北欧国家侧重于 WBS 监测 ARB 的四个主要目标:评估人群中的 ARB、识别逃避污水处理的 ARB、量化去除率以及评估处理过程中潜在的 ARB 进化。在临床和污水两种情况下,研究最多的目标是产生碳青霉烯酶和扩展谱β-内酰胺酶(ESBL)的病原体,主要是大肠杆菌和克雷伯氏菌属。然而,万古霉素耐药肠球菌(VRE)和耐甲氧西林金黄色葡萄球菌(MRSA)在临床流行病学中的研究比污水研究更为关注,这可能是由于其在污水中的检测率较低。临床监测主要使用培养、抗生素药敏试验和基因分型,但 WBS 除了培养技术外,还采用了基于 PCR 和宏基因组学的技术。国际旅行和国外住院治疗引起的输入病例似乎经常导致这些国家 ARB 病原体病例的增加。北欧国家之间存在许多相似之处(例如,知识交流实践、抗生素使用模式以及当前的 ARB 状况),这可能有助于在人群水平筛查中开发和实施用于 ARB 的 WBS 方面开展合作。
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