Department of Biology, University of Pisa, Via S. Zeno 35/39, 56127, Pisa, Italy.
Department of Life Sciences and Systems Biology, University of Torino, Via Accademia Albertina 13, 10123, Torino, Italy.
Environ Res. 2024 Dec 15;263(Pt 1):120075. doi: 10.1016/j.envres.2024.120075. Epub 2024 Sep 27.
Environmental matrices have been considered of paramount importance in the spread of antibiotic-resistance; however, the role of drinking waters is still underexplored. Therefore, a scoping review was performed using a systematic approach based on PRISMA guidelines, with the aim of identifying and characterizing antibiotic-resistance in tap water, specifically, water treated at a potabilization plant and provided for drinking use through a water distribution system. The review included 45 studies, the majority of which were conducted in upper-middle-income economies (42.2%), mainly from the Western Pacific region (26.7%), followed by Europe (24.4%). Most of the papers focused on detecting antibiotic-resistant bacteria (ARB), either alone (37.8%) or in combination with antibiotic-resistant genes (ARGs) (26.7%). Multidrug-resistance profile was often identified in heterotrophic bacteria, including various species of nontuberculous mycobacteria, Pseudomonas spp., and Aeromonas spp., which were especially resistant to penicillins, cephalosporins (including 3rd-generation), and also to macrolides (erythromycin) and tetracyclines. Resistance to a wide range of antibiotics was also prevalent in fecal bacteria, e.g., the Enterobacteriaceae family, with common resistance to (fluoro)quinolones and sulfonamide groups. ARGs were investigated either in bacterial strains isolated from tap waters or directly in water samples, and the most frequently detected ARGs belonged to β-lactam, sulfonamide, and tetracycline types. Additionally, mobile genetic elements were found (i.e., int1 and tnpA). Sulfonamides and macrolides were the most frequently detected antibiotics across countries, although their concentrations were generally low (<10 ng/L) in Europe and the United States. From a health perspective, tap water hosted ARB of health concern based on the 2024 WHO bacterial priority pathogens list, mainly Enterobacteriaceae resistant to 3rd-generation cephalosporin and/or carbapenem. Despite the fact that tap water is treated to meet chemical and microbiological quality standards, current evidence suggests that it can harbor antibiotic-resistance determinants, thus supporting its potential role in environmental pathways contributing to antibiotic resistance.
环境基质在抗生素耐药性的传播中被认为至关重要；然而，饮用水的作用仍未得到充分探索。因此，我们采用基于 PRISMA 指南的系统方法进行了范围界定综述，旨在确定和描述自来水中的抗生素耐药性，特别是在水净化厂处理后通过供水管网提供的饮用水。该综述共纳入 45 项研究，其中大部分研究在中上收入经济体中进行（42.2%），主要来自西太平洋地区（26.7%），其次是欧洲（24.4%）。大多数研究侧重于检测抗生素耐药细菌（ARB），要么单独检测（37.8%），要么与抗生素耐药基因（ARGs）联合检测（26.7%）。在异养细菌中经常检测到多药耐药谱，包括各种非结核分枝杆菌、假单胞菌属和气单胞菌属等，这些细菌对青霉素、头孢菌素（包括第三代）以及大环内酯类（红霉素）和四环素类药物具有较强的耐药性。在粪便细菌中也普遍存在对多种抗生素的耐药性，例如肠杆菌科，常见的耐药类型为（氟）喹诺酮类和磺胺类。ARGs 要么在从自来水中分离的细菌株中进行检测，要么直接在水样中进行检测，最常检测到的 ARGs 属于β-内酰胺类、磺胺类和四环素类。此外，还发现了可移动遗传元件（即 int1 和 tnpA）。磺胺类和大环内酯类是各国最常检测到的抗生素，尽管它们的浓度在欧洲和美国通常较低（<10 ng/L）。从健康角度来看，自来水中存在的抗生素耐药菌是世卫组织 2024 年细菌优先病原体清单中关注的健康风险菌，主要是对第三代头孢菌素和/或碳青霉烯类耐药的肠杆菌科。尽管自来水经过处理以满足化学和微生物质量标准，但现有证据表明，自来水中可能存在抗生素耐药决定因素，这支持了其在抗生素耐药性环境传播途径中可能发挥的作用。
