摘要

       由于不必要地使用抗生素的增加，多药耐药性 (MDR) 的出现已成为全球健康威胁。多药耐药细菌主要通过在移动遗传元件 (MGE) 上积累耐药基因而产生，这可能是通过水平基因转移 (HGT) 实现的。人类和动物的内脏以及自然和工程环境，如污水处理厂和肥料土壤，已被证明是传播抗生素抗性基因 (ARG) 的主要储存库和热点。由于这些环境通过在人-动物-环境界面发生的复杂相互作用支持 MGE 的传播，一个日益增长的 One Health 挑战是多个部门进行沟通和共同努力，以防止 MDR 细菌的出现和传播。然而，在没有抗生素的情况下，在细菌染色体和/或质粒中维持 ARGs 可能会给细菌健康带来能量负担，而那些不必要的 ARGs 最终可能会丢失。本综述强调并总结了目前对人-动物-环境界面中 MDR 细菌中 ARG 基因获得和损失的研究。我们还建议替代疗法，例如联合疗法或不同类别抗生素/佐剂的顺序使用、酶抑制剂治疗和抗生素噬菌体疗法，以从 One Health 问题的角度解决 MDR 问题。

       The emergence of multidrug resistance (MDR) has become a global health threat due to the increasing unnecessary use of antibiotics. Multidrug resistant bacteria occur mainly by accumulating resistance genes on mobile genetic elements (MGEs), made possible by horizontal gene transfer (HGT). Humans and animal guts along with natural and engineered environments such as wastewater treatment plants and manured soils have proven to be the major reservoirs and hot-spots of spreading antibiotic resistance genes (ARGs). As those environments support the dissemination of MGEs through the complex interactions that take place at the human-animal-environment interfaces, a growing One Health challenge is for multiple sectors to communicate and work together to prevent the emergence and spread of MDR bacteria. However, maintenance of ARGs in a bacterial chromosome and/or plasmids in the environments might place energy burdens on bacterial fitness in the absence of antibiotics, and those unnecessary ARGs could eventually be lost. This review highlights and summarizes the current investigations into the gain and loss of ARG genes in MDR bacteria among human-animal-environment interfaces. We also suggest alternative treatments such as combinatory therapies or sequential use of different classes of antibiotics/adjuvants, treatment with enzymeinhibitors, and phage therapy with antibiotics to solve the MDR problem from the perspective of One Health issues.

https://link.springer.com/article/10.1007/s12275-021-1085-9