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[背景]直到最近,人们才明确环境能影响抗生素耐药性风险对临床结果的影响,但迄今为止,很少有文献记录正式评估这些风险的方法。[目标]我们研究可能的方法,并试图确定人类健康风险评估(HHRA)的研究需求,这项评估注重环境在抗生素耐药性病原体所致的抗生素治疗失败中所起的作用。[方法]作者参加了2012年3月4—8日在加拿大魁北克省举行的研讨会,定义抗生素耐药性风险与人类健康环境评估的范围和目标。我们专注于环境中耐药性产生“热点区域”的关键要素,(与食品无关的)暴露评估以及剂量反应,以描述风险特征,从而改善抗生素耐药性管理的方案。[讨论]识别传统风险评估中有助于评估环境中抗生素耐药性的各个新方面。包括:a)解释附加的选择压力对环境耐药基因组的作用,即随着时间的推移,促使抗生素耐药性细菌(ARB)产生;b)在相关的环境组成部分的“热点区域”中识别和描述水平基因转移(HGT)率;c)针对不同健康结局和途径的ARB剂量修改传统的剂量反应方法。[结论]我们建议将抗生素耐药性产生造成的环境影响纳入所有涉及ARB的HHRA过程之中。由于可用的数据有限,一种多标准决策分析方法将有助于进行环境中抗生素耐药性的HHRA,并使风险管理者了解环境抗生素耐药性。
[Background] Until recently it was clear that the environment can affect the impact of antibiotic resistance on clinical outcomes, but to date there is little literature that formally evaluates these risks. [Objectives] We examine possible approaches and try to determine the research needs of the Human Health Risk Assessment (HHRA), which focuses on the role of the environment in the failure of antibiotic treatment due to antibiotic-resistant pathogens. [Method] The authors participated in a workshop held in Quebec, Canada, March 4-8, 2012, to define the scope and goals of assessing the risks of antibiotic resistance and human health. We focus on programs that improve the management of antibiotic resistance by defining the key characteristics of drug resistance in the environment, the key elements of the ’hotspot’, the (non-food) exposure assessment and the dose response to characterize the risk profile. [Discussion] Identify new aspects of traditional risk assessment that can help assess antibiotic resistance in the environment. Including: a) explaining the role of the additional selection pressure on the environment-resistant genomes, ie, the development of antibiotic-resistant bacteria (ARBs) over time; b) the “hotspots” of the relevant environmental components Identify and describe horizontal gene transfer (HGT) rates; and c) modify traditional dose response methods for ARB doses for different health outcomes and pathways. [Conclusion] We propose to include the environmental impact of antibiotic resistance in all HHRA processes involving ARB. Due to the limited data available, a multi-criteria decision analysis approach will help to develop an antibiotic-resistant HHRA in the environment and allow risk managers to understand environmental antibiotic resistance.