摘要

       有限的评论调查了废水-人类途径中抗菌素耐药基因 (ARG) 的来源、行为和健康风险。目前的审查旨在：（1）确定 ARG 的热点来源，及其在废水中的行为和归宿； (2) 讨论 ARG 健康风险和风险因素； (3) 突出未来的研究方向。广泛报道了多种 ARG 对常见和最后的抗微生物药物具有单一和多重耐药性。 ARG 的热点来源包括医疗设施、制药业、水产养殖和动物系统。非工程垃圾填埋场、现场卫生设施、殡仪馆和墓地构成了研究不足的潜在热点来源。水文过程、风和媒介将 ARG 从源头动员到水生系统中。废水处理过程、ARG 的性质和环境条件控制着 ARG 的行为和归宿。被污染的食物和水的消耗、媒介、吸入和皮肤接触会将 ARG 从废水转移到人类。健康风险包括抗菌素耐药性的发展，尽管将废水中的 ARG 与耐药性直接联系起来的证据仍然薄弱。生态风险包括生理行为、群落结构和生态系统功能的变化，包括休克反应和毒力的表达、生物膜形成和突变。这些转变可能会增加病原微生物的定殖能力和存活率，从而构成重大的生态、人类和动物健康风险。总体而言，ARGs 的行为和风险受复杂的人与环境相互作用的控制，具有深远的政策影响，因此 ARGs 可以被视为一个“超级邪恶”的问题。为了最大限度地降低风险，强调了一个包含十点战略的概念框架。研究不足的热点来源、行为和归宿、人类生态毒理学和风险评估值得进一步研究。

       Limited reviews have investigated sources, behaviour and health risks of antimicrobial resistance genes (ARGs) in the wastewater-human pathway. The current review seeks to: (1) determine hotspot sources of ARGs, and their behaviour and fate in wastewaters; (2) discuss ARG health risks, and risk factors; and (3) highlight future research directions. Diverse ARGs conferring single and multi-drug resistance to common and last-resort antimicrobials are widely reported. Hotspot sources of ARGs include medical facilities, pharmaceutical industries, aquaculture and animal systems. Non-engineered landfills, on-site sanitation, funeral parlours and gravesites constitute under-studied potential hotspot sources. Hydrological processes, wind and vectors mobilize ARGs from sources into aquatic systems. Wastewater treatment processes, the nature of ARGs and environmental conditions control the behaviour and fate of ARGs. Consumption of contaminated food and water, vectors, inhalation and dermal contact transfer ARGs from wastewaters to humans. Health risks include development of antimicrobial resistance, although evidence directly linking ARGs in wastewater to resistance remains weak. Ecological risks include shifts in physiological behaviour, community structure and ecosystem functions, including expression of shock-responses and virulence, biofilm formation and mutations. These shifts could increase colonization ability and survival of pathogenic microbes, thereby posing significant ecological, human and animal health risks. Overall, the behaviour and risks of ARGs are controlled by complex human-environmental interactions, and have far-reaching policy implications, hence ARGs can be considered as a ‘super-wicked’ problem. To minimize the risks, a conceptual framework entailing a ten-point strategy is highlighted. Under-studied hotspot sources, behaviour and fate, human ecotoxicology and risk assessments warrant further research.

https://www.sciencedirect.com/science/article/abs/pii/S2213343718301015