抗生素耐药性的来源与控制对策

Antibiotic Resistance: Sources and Mitigation

        朱永官(中国科学院城市环境研究所, 中国科学院城市环境与健康重点实验室 厦门361021;中国科学院生态环境研究中心, 区域与城市生态国家重点实验室 北京100085)
        欧阳纬莹(中国科学院城市环境研究所, 中国科学院城市环境与健康重点实验室 厦门361021)
        吴楠(天津农学院 天津300384)
        苏建强(中国科学院城市环境研究所, 中国科学院城市环境与健康重点实验室 厦门361021)
        乔敏(中国科学院生态环境研究中心, 区域与城市生态国家重点实验室 北京100085)

         城市化;抗生素;耐药性;超级细菌;环境健康

        urbanization;antibiotics;antibiotic resistance;superbug;environmental health

        抗生素除了大量用于人类疾病的治疗外,还作为饲料添加剂被广泛应用于动物养殖业.微生物的抗生素耐药性就是指微生物能够在抗生素存在的情况下生长和繁殖.抗生素耐药性是环境微生物固有的,即所谓的内在抗性,但是人类大量使用抗生素带来的抗生素抗性基因的扩散和传播普遍存在,且已开始威胁到全球人群的健康.微生物对抗生素的抗性主要有3 个机制:(1)抗生素的外排;(2)抗生素的降解或修饰;(3)抗生素作用位点的保护.大量研究表明,抗生素的使用和抗生素抗性的蔓延呈现良好的相关性,而且环境微生物的抗性可以通过基因横向转移向人类致病菌扩散,最终可能导致超级细菌的爆发,直接影响人类健康.为了应对全球性的抗生素抗性问题,必须加强:(1)全球抗生素使用和环境排放的监管政策和管理体系;(2)建立快速和透明的抗生素耐药性监测体系,使其涵盖医院、养殖业、污水处理厂等;(3)建立抗生素药物创新基金,通过政府和企业的联合,加快新型药物的研制;同时加强知识产权保护,使新药创制走上可持续之路;(4)加强抗生素耐药性相关的基础与应用研究,包括耐药性发生和传播的生态学机制,消除和缓解耐药性发生和传播的环境技术及其系统解决方案等,包括改进污水处理厂的处理工艺,削减出水中抗性基因和抗性菌的比例;(5)加强抗生素耐药性的科普宣传,提高全社会对耐药性的认知能力,从而在源头上有效控制抗生素在农业和医疗方面的滥用及其环境污染.

        Alexander Fleming's discovery of a fungus producing penicillin more than 80 years ago has been regarded as a major breakthrough in medical science in human history. Nobel Prize for medicine or physiology was awarded three times to those who discovered novel antibiotics. Antibiotics have been widely used not only in human beings but also in animals for growth promotion and infectious disease control. Antibiotic resistance is defined as the microbial ability to sustain and multiply in the presence of antibiotics. Antibiotic resistance is ancient and ubiquitous in environmental microbes, particularly soils where many antibiotics have been discovered so far, and this original resistance is viewed as intrinsic resistance. Nevertheless, the intensive use of anti-biotics in humans and animals have undoubtedly increased the emergence and abundance of antibiotic resistance in the environment, and therefore threatening global human health. Overall, there are three mechanisms that enable the microbes to resist antibiotics:( 1)efflux pumps;(2)deactivation or degradation of antibiotics;(3)protection of targets in bacterial cells. Numerous studies have demonstrated that the use of antibiotics and residual discharge into the environment is well correlated with the abundance of antibiotic resistance. Antibiotic resistance can spread via not only vertical gene transfer but also horizontal gene transfer(HGT), and eventually to human pathogens, and even the emergence of superbugs. In 2006 Pruden et al. explicitly proposed antibiotic resistance as emerging contaminants, and pointed out that conventional environmental treatment systems were not designed to remove these emerging contaminants. In order to combat global antibiotic resistance, we must take the following actions and measures:(1)to establish global management system to regulate the use and discharge of antibiotics;(2) to develop rapid and transparent global surveillance system on antibiotic resistance, covering clinical environments, animals farms and urban wastewater treatment facilities;(3)to set up global innovation fund for new drug development and intellectual property protection system so that drug develop is sustainable;(4)to strengthen fundamental and applied research on environmental antibiotic resistance, including the emergence and spread of resistance, mitigation technologies and solutions, such as advanced water treatment technologies to reduce resistant bacteria in effluent;(5)and to improve public awareness of antibiotic resistance, therefore control the misuse of antibiotics in agricultural and medical industries and environmental pollution from the root cause.