摘要

       抗生素耐药性是一场全球性的健康危机，与人类和动物中抗生素使用增加且通常不受限制有关。作为世界上最大的抗生素生产国和消费国之一，中国见证了这场危机的一些最严重的症状。抗生素和抗生素抗性基因 (ARG) 广泛分布于地表水、污水处理厂流出物、土壤和动物粪便中。 ARGs 在诊所/医院中的出现和流行，尤其是耐碳青霉烯的革兰氏阴性菌，引起了公共卫生官员的关注。了解中国抗生素使用现状及其与 ARG 流行率和环境多样性的关系非常重要。在这里，我们回顾了这些关系及其与临床环境中观察到的抗菌素耐药性 (AMR) 趋势的相关性。本综述强调了 ARG 在环境中的富集和传播问题，以及未来在减轻抗生素耐药性在环境中传播的需求，特别是在“行星健康”的角度下，即维持或威胁人类健康的系统。 

       Antibiotic resistance is a global health crisis related to the increasing and often unrestricted use of antibiotics in humans and animals. As one of the world's largest producers and consumers of antibiotics, China has witnessed some of the worst symptoms of this crisis. Antibiotics and antibiotic resistance genes (ARG) are widely distributed in surface water, sewage treatment plant effluent, soil and animal feces. The emergence and prevalence of ARGs in clinics/hospitals, especially carbapenem-resistant Gram-negative bacteria, has attracted the attention of public health officials. It is important to understand the current status of antibiotic use in China and its relationship with ARG prevalence and environmental diversity. Here, we review these relationships and their relevance to antimicrobial resistance (AMR) trends observed in the clinical setting. This review emphasizes the accumulation and spread of ARG in the environment, as well as the future need to reduce the spread of antibiotic resistance in the environment, especially from the perspective of "planetary health", that is, systems that maintain or threaten human health. 

https://www.sciencedirect.com/science/article/pii/S0160412017312321