Table5_Antimicrobials and Antibiotic Resistance Genes in Water Bodies: Pollution, Risk, and Control.DOCX

The manuscript endeavors to provide a perspective on the role of water bodies in the spread of antimicrobial (antibiotic) resistance (AMR), antimicrobial resistant bacteria (ARB), and antimicrobial resistance genes (ARGs) among pathogens, animals, and humans. We briefly indicate how the AMR problem is globally affecting public health, along with strategies and mechanisms to combat the dissemination of ARB and ARGs. A brief systematic survey of the literature (2015-onwards) for the presence of antimicrobial residues and the occurrence of ARGs and antimicrobial resistant microorganisms in different water bodies/sources indicates the gravity of the situation and suggests their important role in the occurrence and spread of AMR, ARB, and ARGs. The prevalent water treatment methods which tend to reduce ARB and ARGs from water resources are unable to remove them completely, allowing the problem of AMR to continue and spread to organisms of concern. In this opinion article, we attempt to underline the key role of controlling the release/discharge of antimicrobial contaminants in water bodies and their buildup in checking the development and spread of AMR. The reduction in the release of antibiotic residues in the environment, especially water bodies, combined with the development of improved surveillance means and efficacious treatment/removal/decomposition methods could help curb the menace of AMR effectively. We suggest the expansion of the ambit of ‘One Health Approach to AMR crises proposed by the World Bank, 2021 to include the ‘reduction of antimicrobial contamination of the environment’ as the ‘seventh domain’ of activity to effectively achieve its objective.

本文旨在探讨水体在病原体、动物与人类之间的抗微生物（抗生素）耐药性（AMR，Antimicrobial Resistance）、抗微生物耐药细菌（ARB，Antimicrobial Resistant Bacteria）以及抗微生物耐药基因（ARGs，Antimicrobial Resistance Genes）的传播过程中所发挥的作用。本文简要阐述了AMR问题在全球范围内对公共卫生造成的冲击，以及遏制ARB与ARGs传播的相关策略与作用机制。本研究对2015年至今的相关文献开展了简要系统综述，梳理了不同水体/水源中抗微生物残留、ARGs以及抗微生物耐药微生物的检出情况，结果凸显了该问题的严峻性，同时证实了水体在AMR、ARB与ARGs的产生与传播中扮演的核心角色。当前主流的水处理技术虽可在一定程度上降低水资源中的ARB与ARGs含量，但无法将其完全去除，致使AMR问题持续存在并向受关注的生物体进一步扩散。在这篇观点性文章中，我们旨在强调管控水体中抗微生物污染物的排放及其累积，对于遏制AMR的产生与传播具有关键作用。减少环境（尤其是水体）中抗生素残留的排放，同时开发更完善的监测手段与高效的处理、去除或降解技术，可有效遏制AMR带来的公共健康威胁。我们建议将世界银行2021年提出的“应对AMR危机的同一健康方案”（One Health Approach）的覆盖范围拓展，将“降低环境抗微生物污染”纳入其活动的“第七领域”，以有效实现该方案的既定目标。