Background

Antimicrobial resistance is becoming a major threat to public health and there is much current activity to ameliorate that threat. However, the relative contributions that potential sources of antimicrobial resistant (AMR) bacteria represent are not well established. Over-prescription of antimicrobials by clinicians is one source of selection for AMR bacteria/genes, but antimicrobials are used in greater quantities in food production. These bacteria/genes can then reach humans via food, the environment, or other means.

Scope and approach

Summarised in this review are potential transmission routes of AMR bacteria/genes from agricultural production to human infections. The situation is complicated, and it is difficult to compare studies because of different methodologies and definitions of resistance being used. Data and examples to illustrate each transmission route are provided where available.

Key findings and conclusions

Quantitative data for defined organism/phenotype/gene combinations for exposure assessment are rare. Another problem is the identification of indistinguishable AMR bacteria in foods and human cases, which is invariably taken to show that food consumption is a source of infections. However, these data do not show the direction in which the flow of the organism/gene occurred nor do they rule out another source(s), and such data are scant. Case control studies could identify food exposures associated with particular organism/gene infections. The construction of models representing potential transmission pathways may help to reveal their relative contributions. However, the data may not be available to support these models. The lack of coherent data hampers the development of effective policy.

中文翻译：

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农业食品链与抗菌素耐药性研究进展

背景

抗菌素耐药性正成为对公共卫生的主要威胁，目前有许多活动可以缓解这种威胁。但是，尚未很好地确定抗微生物抗药性（AMR）细菌的潜在来源所代表的相对贡献。临床医生对抗菌素的过度处方是选择AMR细菌/基因的一种方法，但是抗菌素在食品生产中被大量使用。这些细菌/基因然后可以通过食物，环境或其他方式到达人类。

范围和方法

本综述总结了AMR细菌/基因从农业生产到人类感染的潜在传播途径。情况复杂，由于使用了不同的抗药性方法和定义，因此很难比较研究。在可用的情况下，提供了说明每个传输路径的数据和示例。

主要发现和结论

用于暴露评估的确定的生物/表型/基因组合的定量数据很少。另一个问题是在食品和人类病例中无法区分的AMR细菌的鉴定，这总是表明食品的消费是感染的来源。但是，这些数据没有显示出生物体/基因的流动发生的方向，也没有排除其他来源，因此这些数据很少。病例对照研究可以确定与特定生物/基因感染相关的食物暴露。代表潜在传播途径的模型的构建可能有助于揭示它们的相对贡献。但是，数据可能无法支持这些模型。缺乏连贯的数据阻碍了有效政策的制定。