摘要

抗生素在人类医学和兽医学中的大量使用，导致了抗生素和抗生素耐药性向环境中的广泛传播。近年来，各种研究表明，抗生素残留、耐药菌和耐药基因均存在于水生环境中，临床废水似乎是抗生素耐药环境传播的热点。本文对不同采样点进行了有代表性的统计分析，这些采样点含有不同比例的临床影响废水。统计分析包括计算抗生素与耐药细菌或耐药基因的任何组合的比例。在同时存在抗生素残留的情况下，对结果进行筛选，以提高检测到耐药细菌或耐药基因的概率。然后，在所调查的采样点，将阳性相关集与检测到的中位浓度进行比较。结果表明，临床废水比例最高的采样点往往形成一个明显的耐药种群。本研究的结果表明，环丙沙星是一个很好的指标用来指示多重耐药铜绿假单胞菌和产超广谱β-内酰胺酶（ESBL）的克雷伯氏菌、肠杆菌和柠檬酸杆菌的存在，因为它与这两个参数正相关。此外，不论是哪个采样点，碳青霉烯酶基因和美罗培南之间都存在精确关的系。这些结果突出了临床废水对多重耐药性传播和发展的作用。

The high use of antibiotics in human and veterinary medicine has led to a wide spread of antibiotics and antimicrobial resistance into the environment. In recent years, various studies have shown that antibiotic residues, resistant bacteria and resistance genes, occur in aquatic environments and that clinical wastewater seems to be a hot spot for the environmental spread of antibiotic resistance. Here a representative statistical analysis of various sampling points is presented, containing different proportions of clinically influenced wastewater. The statistical analysis contains the calculation of the odds ratios for any combination of antibiotics with resistant bacteria or resistance genes, respectively. The results were screened for an increased probability of detecting resistant bacteria, or resistance genes, with the simultaneous presence of antibiotic residues. Positive associated sets were then compared, with regards to the detected median concentration, at the investigated sampling points. All results show that the sampling points with the highest proportion of clinical wastewater always form a distinct cluster concerning resistance. The results shown in this study lead to the assumption that ciprofloxacin is a good indicator of the presence of multidrug resistant P. aeruginosa and extended spectrum β-lactamase (ESBL)-producing Klebsiella spec., Enterobacter spec. and Citrobacter spec., as it positively relates with both parameters. Furthermore, a precise relationship between carbapenemase genes and meropenem, regarding the respective sampling sites, could be obtained. These results highlight the role of clinical wastewater for the dissemination and development of multidrug resistance.

https://www.sciencedirect.com/science/article/pii/S0045653519322714