摘要

对抗菌素耐药性构成威胁的反应不足。大多数注意力都集中在人类医学和农业中抗性生物的出现上。对抗生素污染环境的关注较少。为协助健康倡导者参与此问题，我们审查了有关农业，水产养殖，生活垃圾和药品生产在抗生素耐药性传播中的作用的证据，得出结论认为所有这些活动都构成了潜在的严重威胁。然后，我们研究了通过具体措施减轻这种威胁的方法，例如改进废水处理流程，减少制造排放，考虑采购和药物批准决策中的环境影响，以及更好的粪便管理。最后，我们将这个问题置于越来越多关于健康商业决定因素的文献中，强调需要独立于既得利益而制定有效的立法和监管。

Responses to the threat posed by antimicrobial resistance have been inadequate. Most attention has focused on the emergence of resistant organisms in human medicine and in agriculture. Much less attention has been given to antibiotic contamination of the environment. To assist health advocates to engage with this issue, we review the evidence on the role of agriculture, aquaculture, domestic waste and pharmaceutical manufacturing in the spread of antibiotic resistance, concluding that all of these activities pose a potentially serious threat. We then examine ways that this threat might be mitigated by specific measures, such as improved wastewater treatment processes, reduction of manufacturing emissions, consideration of environmental impacts in procurement and drug approval decisions, and better manure management. We conclude by placing this problem within the growing literature on commercial determinants of health, stressing the need for effective legislation and regulation developed independent of vested interests.

https://www.ncbi.nlm.nih.gov/pubmed/30297918