Translating antibiotic prescribing into antibiotic resistance in the environment: A hazard characterisation case study.

Autor: Singer AC; NERC Centre for Ecology & Hydrology, Benson Lane, Wallingford, United Kingdom., Xu Q; NERC Centre for Ecology & Hydrology, Benson Lane, Wallingford, United Kingdom.; Environmental Diagnosis and Management, Royal Holloway University of London, Egham, United Kingdom., Keller VDJ; NERC Centre for Ecology & Hydrology, Benson Lane, Wallingford, United Kingdom.
Jazyk: angličtina
Zdroj: PloS one [PLoS One] 2019 Sep 04; Vol. 14 (9), pp. e0221568. Date of Electronic Publication: 2019 Sep 04 (Print Publication: 2019).
DOI: 10.1371/journal.pone.0221568
Abstrakt: The environment receives antibiotics through a combination of direct application (e.g., aquaculture and fruit production), as well as indirect release through pharmaceutical manufacturing, sewage and animal manure. Antibiotic concentrations in many sewage-impacted rivers are thought to be sufficient to select for antibiotic resistance genes. Yet, because antibiotics are nearly always found associated with antibiotic-resistant faecal bacteria in wastewater, it is difficult to distinguish the selective role of effluent antibiotics within a 'sea' of gut-derived resistance genes. Here we examine the potential for macrolide and fluoroquinolone prescribing in England to select for resistance in the River Thames catchment, England. We show that 64% and 74% of the length of the modelled catchment is chronically exposed to putative resistance-selecting concentrations (PNEC) of macrolides and fluoroquinolones, respectively. Under current macrolide usage, 115 km of the modelled River Thames catchment (8% of total length) exceeds the PNEC by 5-fold. Similarly, under current fluoroquinolone usage, 223 km of the modelled River Thames catchment (16% of total length) exceeds the PNEC by 5-fold. Our results reveal that if reduced prescribing was the sole mitigating measure, that macrolide and fluoroquinolone prescribing would need to decline by 77% and 85%, respectively, to limit resistance selection in the catchment. Significant reductions in antibiotic prescribing are feasible, but innovation in sewage-treatment will be necessary for achieving substantially-reduced antibiotic loads and inactivation of DNA-pollution from resistant bacteria. Greater confidence is needed in current risk-based targets for antibiotics, particularly in mixtures, to better inform environmental risk assessments and mitigation.
Competing Interests: Andrew Singer status as Academic Editor for PLOS ONE and handling editor in the Antimicrobial Resistance call for papers does not alter our adherence to PLOS ONE policies on sharing data and materials
Databáze: MEDLINE
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