摘要

      抗微生物耐药性（AMR）无疑是一个至关重要的“同一健康”挑战，其基础是人类、动物和环境的相互依赖。AMR的后果─抗菌药物治疗人畜感染的失败─直接影响人类和动物的健康和福祉，并导致社会经济损失。因此，如果没有以人类为中心的病因观点，仅研究水、土壤和空气环境区室中的AMR是不够的。任何调查都应该考虑AMR通过我们的饮食、呼吸和触摸传播给人类的机制和风险。同样，当与保持医学上重要的抗微生物药物的疗效有关时，对抗微生物耐药性基因（ARGs）在环境介质中的进化和传播的研究是最相关的。(1)
最近环境AMR研究呈指数级增长，往往关注范围狭窄，缺乏对健康结果的相关性和影响。这限制了研究结果的适用性，并可能导致对环境作用的过度或低估。例如，仅仅关注基于定量或实时聚合酶链式反应（qPCR）或基于宏基因组学的ARG丰度测量会使许多与健康无关的ARG被错误定位；忽视构成AMR的群体水平获取的总暴露途径可能导致对总暴露的低估。在这一观点中，我们强调了该领域研究人员面临的几个关键问题，并邀请“致编辑的信”回复，以便更好地定义AMR环境层面的影响贡献，作为更广泛的“同一健康”愿景的一部分。
Antimicrobial resistance (AMR) is undoubtedly a vital “One Health” challenge underpinned by the interdependence of humans, animals, and the environment. The consequences of AMR─the failure of antimicrobials to cure infections in humans and livestock─directly affect human and animal health and wellbeing and result in socioeconomic loss. As a result, it is insufficient to only study AMR in the environmental compartments of water, soil, and air without an anthropocentric etiological perspective. Any investigation should consider the mechanisms and risks of AMR transmission to humans from what we eat, drink, breathe, and touch. Similarly, investigations on the evolution and transmission of antimicrobial resistance genes (ARGs) in environmental media are most relevant when there is a connection to preserving the efficacy of medically important antimicrobials. (1)
The recent exponential growth in environmental AMR research has often been narrowly focused and lacking the relevance and impact to health outcomes. This limits the applicability of the findings and can result in an over- or underestimation of the role of the environment. For example, focusing merely on quantitative or real-time polymerase chain reaction (qPCR)-based or metagenomics-based measurements of ARG abundances renders many health-irrelevant ARGs mistargeted; overlooking the aggregate exposure pathways constituting a population-level acquisition of AMR can lead to an underestimation of overall exposure. In this Viewpoint, we highlight several critical issues for researchers working in this field and invite a “Letter to Editor” response in order to better define impactful contributions from the environmental dimension of AMR as part of a broader “One Health” vision.

https://pubs.acs.org/doi/full/10.1021/acs.est.2c01651