摘要
      作为一个典型的“同一健康”问题，抗微生物耐药性（AMR）可以通过多种途径在环境中传播，从而构成人类-动物环境循环的一个组成部分。直到最近，空气才被认为是抗生素耐药性基因（ARGs）和抗生素耐药性细菌传播的潜在重要途径。这篇综述介绍了目前关于假设的从排放源传播到人类气道的知识，以及影响环境因素和由此产生的健康影响。ARGs在特定来源和环境空气中的存在已不再是问题。需要量化抗生素耐药性细菌的运输倾向，以评估职业人群和普通人群的吸入暴露程度。反应性大气成分和主要气象条件强烈影响环境可吸入ARGs的动态和暴露。考虑到空气污染和气候变化的演变趋势，需要系统地研究这种对抗生素耐药性病原体的影响。最终的问题是可吸入AMR与健康和患病人类气道中微生物群相互作用的命运和后果，这将阐明AMR在导致急性和慢性呼吸道疾病的病毒-细菌共同感染中的作用。我们提出了一个整体的方法框架来解决主要的研究空白，以建立抗微生物耐药性的空气传播链。深入了解这些问题将有助于制定有效的控制和管理措施，最大限度地减少AMR的空气传播，这是保护大量人群健康的一个不可或缺的环境层面。
Abstract
As a quintessential “One Health” issue, antimicrobial resistance (AMR) can be transmitted in the environment via multiple pathways, thereby constituting an integral dimension of the human-animal-environment loop. Only recently has air been recognized as a potentially important pathway for the dissemination of antibiotic resistance genes (ARGs) and antibiotic-resistant bacteria. This review presents the current know-how about the hypothesized dissemination from emission sources to human airways in association with influencing environmental factors and the consequent health implications. The presence of ARGs in source-specific and ambient air is no longer in question. The transport propensity of antibiotic-resistant bacteria needs to be quantified in order to assess the magnitude of the inhalation exposure of occupational and general populations. Reactive atmospheric components and prevailing meteorological conditions strongly influence the dynamics of and exposure to ambient inhalable ARGs. Considering the evolving trends of air pollution and climate change, such impacts on antibiotic-resistant pathogens need to be systematically studied. The ultimate question is the fate and consequences of inhalable AMR in interaction with microbiomes in healthy and diseased human airways, which would shed light on the role of AMR in viral-bacterial co-infections leading to acute and chronic respiratory diseases. We put forward a holistic methodological framework to address the major research gaps to establish the airborne transmission chain of antimicrobial resistance. An advanced understanding of these issues will be of benefit in devising effective control and management measures to minimize the airborne transmission of AMR, an integral environmental dimension to protecting the health of large populations.

https://www.tandfonline.com/doi/full/10.1080/10643389.2021.2006537