Université de Franche-Comté, UMR 6249 Chrono-environnement, F-25000 Besançon, France.
Université de Franche-Comté, UMR 6249 Chrono-environnement, F-25000 Besançon, France.
Infect Dis Now. 2024 Jun;54(4):104895. doi: 10.1016/j.idnow.2024.104895. Epub 2024 Mar 26.
Antimicrobial resistance (AMR) is a major public health challenge. For several years, AMR has been addressed through a One Health approach that links human health, animal health, and environmental quality. In this review, we discuss AMR in different reservoirs with a focus on the environment. Anthropogenic activities produce effluents (sewage, manure, and industrial wastes) that contaminate soils and aquatic environments with antibiotic-resistant bacteria (ARB), antibiotic-resistant genes (ARGs), and selective agents such as antibiotics, biocides, and heavy metals. Livestock treated with antibiotics can also contaminate food with ARB. In high-income countries (HICs), effective sanitation infrastructure and limited pharmaceutical industries result in more controlled discharges associated with human activities. Hence, studies using genome-based typing methods have revealed that, although rare inter-reservoir transmission events have been reported, human acquisition in HICs occurs primarily through person-to-person transmission. The situation is different in low- and middle-income countries (LMICs) where high population density, poorer sanitation and animal farming practices are more conducive to inter-reservoir transmissions. In addition, environmental bacteria can be a source of ARGs that, when transferred to pathogenic species under antibiotic selection pressure in environmental hotspots, produce new antibiotic-resistant strains that can potentially spread in the human community through human-to-human transmission. The keys to reducing AMR in the environment are (i) better treatment of human waste by improving wastewater treatment plants (WWTPs) in HICs and improving sanitation infrastructure in LMICs, (ii) reducing the use of antibiotics by humans and animals, (iii) prioritizing the use of less environmentally harmful antibiotics, and (iv) better control of pharmaceutical industry waste.
抗微生物药物耐药性（AMR）是一个主要的公共卫生挑战。多年来，人们一直采用一种“同一健康”方法来应对 AMR，该方法将人类健康、动物健康和环境质量联系起来。在这篇综述中，我们讨论了不同储层中的 AMR，重点是环境。人为活动产生的废水（污水、粪便和工业废物）会使土壤和水生环境受到抗生素耐药细菌（ARB）、抗生素耐药基因（ARGs）和抗生素、杀生剂和重金属等选择性剂的污染。用抗生素处理过的牲畜也会使食物受到 ARB 的污染。在高收入国家（HICs），有效的卫生基础设施和有限的制药工业导致与人类活动相关的排放得到更好的控制。因此，使用基于基因组的分型方法的研究表明，尽管已经报道了罕见的储层间传播事件，但 HICs 中的人类获得主要是通过人与人之间的传播。在低收入和中等收入国家（LMICs）中，情况则不同，那里人口密度高、卫生条件和动物养殖实践较差，更有利于储层间的传播。此外，环境细菌可以成为 ARGs 的来源，当这些 ARGs 在环境热点中受到抗生素选择压力的影响转移到致病物种时，会产生新的抗生素耐药菌株，这些菌株有可能通过人与人之间的传播在人类社区中传播。减少环境中 AMR 的关键是：（i）通过改善 HICs 中的废水处理厂（WWTPs）和改善 LMICs 的卫生基础设施，更好地处理人类废物；（ii）减少人类和动物使用抗生素；（iii）优先使用对环境危害较小的抗生素；（iv）更好地控制制药工业废物。
