Strategic Approach for Prioritising Local and Regional Sanitation Interventions for Reducing Global Antibiotic Resistance
Strategic Approach for Prioritising Local and Regional Sanitation Interventions for Reducing Global Antibiotic Resistance
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DOI：
10.3390/w11010027
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发表时间：
2019-01-01
期刊：
影响因子：
3.4
通讯作者：
Bunce, Joshua T.
中科院分区：
文献类型：
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作者：
Graham, David W.;Giesen, Myra J.;Bunce, Joshua T.
只有通过一系列多学科行动（一个健康），包括在国际范围内更谨慎地使用抗生素和改善卫生条件，才能扭转全球日益严重的抗生素耐药性（AR）。相对于卫生设施，先进的技术可以减少废物排放中的AR，但这些技术价格昂贵，需要一种战略方法来优先考虑更负担得起的缓解方案，特别是对于低收入和中等收入国家（LMICs）。这里提出了这样一种方法，它覆盖了不同卫生选择的增量成本及其在减少AR方面的相对效益，最终为不同地点提出了下一个最经济的选择。当考虑AR基因的命运与干预成本，减少露天排便（OD）和增加分散的二级污水处理，与公寓下水道，可能会有最大的影响，减少AR，最少的费用。然而，对一个特定国家来说，最佳选择取决于现有的污水处理基础设施。该方法以东南亚为案例研究，利用世界银行/世卫组织/儿童基金会的数据，建议柬埔寨和东帝汶将减少OD作为国家优先事项。相比之下，增加分散的二级处理非常适合泰国、越南和马来西亚农村。我们的方法为决策者提供了一个科学的起点，用于优先考虑AR缓解干预措施;随着更多数据的可用，这种方法将不断发展和完善。
Globally increasing antibiotic resistance (AR) will only be reversed through a suite of multidisciplinary actions (One Health), including more prudent antibiotic use and improved sanitation on international scales. Relative to sanitation, advanced technologies exist that reduce AR in waste releases, but such technologies are expensive, and a strategic approach is needed to prioritize more affordable mitigation options, especially for Low- and Middle-Income Countries (LMICs). Such an approach is proposed here, which overlays the incremental cost of different sanitation options and their relative benefit in reducing AR, ultimately suggesting the next-most-economic options for different locations. When considering AR gene fate versus intervention costs, reducing open defecation (OD) and increasing decentralized secondary wastewater treatment, with condominial sewers, will probably have the greatest impact on reducing AR, for the least expense. However, the best option for a given country depends on the existing sewerage infrastructure. Using Southeast Asia as a case study and World Bank/WHO/UNICEF data, the approach suggests that Cambodia and East Timor should target reducing OD as a national priority. In contrast, increasing decentralized secondary treatment is well suited to Thailand, Vietnam and rural Malaysia. Our approach provides a science-informed starting point for decision-makers, for prioritising AR mitigation interventions; an approach that will evolve and refine as more data become available.