Abstract

As a quintessential “One Health” issue, antimicrobial resistance (AMR) can be transmitted in the environment via multiple pathways, thereby constituting an integral dimension of the human-animal-environment loop. Only recently has air been recognized as a potentially important pathway for the dissemination of antibiotic resistance genes (ARGs) and antibiotic-resistant bacteria. This review presents the current know-how about the hypothesized dissemination from emission sources to human airways in association with influencing environmental factors and the consequent health implications. The presence of ARGs in source-specific and ambient air is no longer in question. The transport propensity of antibiotic-resistant bacteria needs to be quantified in order to assess the magnitude of the inhalation exposure of occupational and general populations. Reactive atmospheric components and prevailing meteorological conditions strongly influence the dynamics of and exposure to ambient inhalable ARGs. Considering the evolving trends of air pollution and climate change, such impacts on antibiotic-resistant pathogens need to be systematically studied. The ultimate question is the fate and consequences of inhalable AMR in interaction with microbiomes in healthy and diseased human airways, which would shed light on the role of AMR in viral-bacterial co-infections leading to acute and chronic respiratory diseases. We put forward a holistic methodological framework to address the major research gaps to establish the airborne transmission chain of antimicrobial resistance. An advanced understanding of these issues will be of benefit in devising effective control and management measures to minimize the airborne transmission of AMR, an integral environmental dimension to protecting the health of large populations.

摘要

作为一个典型的“一个健康”问题，抗菌素耐药性 (AMR) 可以通过多种途径在环境中传播，从而构成人类-动物-环境循环的一个整体维度。直到最近，空气才被认为是传播抗生素抗性基因 (ARG) 和抗生素抗性细菌的潜在重要途径。这篇综述介绍了当前关于从排放源到人类呼吸道的假设传播与影响环境因素和随之而来的健康影响相关的知识。源特定和环境空气中 ARGs 的存在不再是问题。需要量化耐抗生素细菌的运输倾向，以评估职业和一般人群的吸入暴露量。反应性大气成分和普遍的气象条件强烈影响环境可吸入 ARGs 的动态和暴露。考虑到空气污染和气候变化的演变趋势，需要系统研究这种对抗生素耐药病原体的影响。最终的问题是可吸入 AMR 与健康和患病人类气道中微生物组相互作用的命运和后果，这将阐明 AMR 在导致急性和慢性呼吸道疾病的病毒-细菌共感染中的作用。我们提出了一个整体的方法框架来解决主要的研究空白，以建立抗菌素耐药性的空气传播链。