Data_Sheet_1_A one health approach for monitoring antimicrobial resistance: developing a national freshwater pilot effort.xlsx

Antimicrobial resistance (AMR) is a world-wide public health threat that is projected to lead to 10 million annual deaths globally by 2050. The AMR public health issue has led to the development of action plans to combat AMR, including improved antimicrobial stewardship, development of new antimicrobials, and advanced monitoring. The National Antimicrobial Resistance Monitoring System (NARMS) led by the United States (U.S) Food and Drug Administration along with the U.S. Centers for Disease Control and U.S. Department of Agriculture has monitored antimicrobial resistant bacteria in retail meats, humans, and food animals since the mid 1990’s. NARMS is currently exploring an integrated One Health monitoring model recognizing that human, animal, plant, and environmental systems are linked to public health. Since 2020, the U.S. Environmental Protection Agency has led an interagency NARMS environmental working group (EWG) to implement a surface water AMR monitoring program (SWAM) at watershed and national scales. The NARMS EWG divided the development of the environmental monitoring effort into five areas: (i) defining objectives and questions, (ii) designing study/sampling design, (iii) selecting AMR indicators, (iv) establishing analytical methods, and (v) developing data management/analytics/metadata plans. For each of these areas, the consensus among the scientific community and literature was reviewed and carefully considered prior to the development of this environmental monitoring program. The data produced from the SWAM effort will help develop robust surface water monitoring programs with the goal of assessing public health risks associated with AMR pathogens in surface water (e.g., recreational water exposures), provide a comprehensive picture of how resistant strains are related spatially and temporally within a watershed, and help assess how anthropogenic drivers and intervention strategies impact the transmission of AMR within human, animal, and environmental systems.

抗菌药物耐药性（Antimicrobial Resistance，AMR）是全球性公共卫生威胁，据预测到2050年，其每年将在全球造成1000万人死亡。这一公共卫生领域的AMR问题推动了相关防控行动计划的制定，涵盖优化抗菌药物管理、研发新型抗菌药物以及升级监测体系等内容。

由美国食品药品监督管理局（U.S. Food and Drug Administration）、美国疾病预防控制中心以及美国农业部牵头组建的国家抗菌药物耐药性监测系统（National Antimicrobial Resistance Monitoring System，NARMS），自20世纪90年代中期起，便持续对零售肉类、人类群体与食用动物体内的耐药菌开展监测工作。鉴于人类、动物、植物与环境系统均与公共卫生息息相关，目前NARMS正探索整合式的同一健康（One Health）监测模式。

自2020年起，美国环境保护署牵头组建了NARMS跨部门环境工作组（Environmental Working Group，EWG），旨在流域与国家层面落地地表水AMR监测项目（Surface Water AMR Monitoring Program，SWAM）。NARMS环境工作组将环境监测工作的推进划分为五大模块：(i) 明确监测目标与研究问题；(ii) 设计研究方案与采样框架；(iii) 遴选AMR监测指标；(iv) 确立分析检测方法；(v) 制定数据管理、分析及元数据计划。

在本环境监测项目开发前期，针对上述五大模块，工作组均对科学界共识与相关文献进行了全面梳理与审慎考量。

SWAM项目产生的数据将助力构建稳健的地表水监测体系，其核心目标包括：评估地表水中AMR病原体所带来的公共卫生风险（例如休闲水域接触暴露风险）；全面阐明流域内耐药菌株在空间与时间维度上的关联模式；并助力评估人为驱动因素与干预策略如何影响人类、动物与环境系统内AMR的传播。