摘要

    背景：环境中抗生素抗性基因（ARG）的出现和传播构成了巨大的全球健康危害。医院废水（HWW）中存在高浓度的抗生素残留物和抗生素抗性细菌，这可能是ARGs散布到环境中的蓄水池。我们的荟萃分析综合分析了HWW中ARGs的患病率以及影响ARGs分布的因素。

方法：使用在线数据库搜索使用以下主题词的文献：“抗药性”和“基因”，“医院”和“废水”。两位审稿人独立地应用了预定义的标准来评估文献并提取数据，包括“相对丰富的ARGs”，“标题”，“作者”，“国家/地区”，“位置”，“抽样年份”和“抽样季节”。通过Wilcox.test函数计算R中ARGs丰度的中位数和95％置信区间。通过Pearson相关分析和Kruskal-Wallis H检验分析ARGs的时间趋势，空间差异，季节变化和去除效率。

结果：在HWW中发现了对碳青霉烯类，磺酰胺类，四环素类和移动遗传元件的抗性基因，其相对丰度很高（> 10-4基因拷贝/ 16S rRNA基因拷贝）。从2014年到2018年，对广谱β-内酰胺类，碳青霉烯类，磺酰胺类和糖肽类耐药基因的丰度显着下降，而四环素耐药基因的丰度则有所上升。现场HWW处理无法完全去除ARG，并且不同ARG的去除效率会有所不同。

结论：HWW提供了更多类型的ARGs，其丰度高于大多数废水系统中的ARGs。 HWW可能是ARG的储存库，并在ARG的传播中发挥重要作用。

关键词：抗生素抗性基因（ARGs），基因丰度，影响因素，医院废水，荟萃分析 
Bèijǐng: Huánjìng zhōng kàngshēngsù kàng xìng jīyīn (AR

    Background: The emergence and dissemination of antibiotic resistance genes (ARGs) in the environment poses a huge global health hazard. Hospital wastewater (HWW), in which a high density of antibiotic residues and antibiotic-resistant bacteria are present, may be a reservoir of ARGs dissemination into the environment. Our meta-analysis comprehensively analyzes the prevalence of ARGs in HWW, as well as the influencing factors in ARGs distribution.

Methods: Online databases were used to search for literature using the subject terms: “Drug Resistance” AND “Genes” AND “Hospitals” AND “Wastewater.” Two reviewers independently applied predefined criteria to assess the literature and extract data including “relative abundance of ARGs,” “title,” “authors,” “country,” “location,” “sampling year,” and “sampling seasons.” The median values and 95% confidence intervals of ARGs abundance were calculated by Wilcox.test function in R. Temporal trends, spatial differences, seasonal variations and removal efficiency of ARGs were analyzed by Pearson correlation analysis and Kruskal-Wallis H test.

Results: Resistance genes to carbapenems, sulfonamides, tetracyclines and mobile genetic elements were found at high relative abundance (>10−4 gene copies/16S rRNA gene copies) in HWW. The abundance of resistance genes to extended-spectrum β-lactams, carbapenems, sulfonamides and glycopeptide significantly decreased, while tetracycline resistance genes abundance increased from 2014 to 2018. The abundance of ARGs was significantly different by country but not by season. ARGs could not be completely removed by on-site HWW treatments and the removal efficiency varies for different ARGs.

Conclusions: HWW presents more types of ARGs, and their abundance is higher than those in most wastewater systems. HWW may be a reservoir of ARGs and play an important role in the dissemination of ARGs.

Keywords: antibiotic resistance genes (ARGs), gene abundance, influencing factors, hospital wastewater, meta-analysis

    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7655780/