Exposure to and colonisation by antibiotic-resistant E. coli in UK coastal water users: Environmental surveillance, exposure assessment, and epidemiological study (Beach Bum Survey)
Exposure to and colonisation by antibiotic-resistant E. coli in UK coastal water users: Environmental surveillance, exposure assessment, and epidemiological study (Beach Bum Survey)
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DOI：
10.1016/j.envint.2017.11.003
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发表时间：
2018-05-01
影响因子：
11.8
通讯作者：
Gaze, William H.
中科院分区：
文献类型：
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作者：
Leonard, Anne F. C.;Zhang, Lihong;Gaze, William H.
背景：抗生素耐药菌（ARB）是一个全球性的公共卫生问题。随着社区获得性耐药感染数量的增加，了解人们接触和被ARB定植的机制可以帮助制定有效的战略，以防止其传播。人们对自然环境在其中所起的作用知之甚少。这是第一个将洗浴水域ARB监测、人类暴露估计以及用水者暴露与ARB定植之间的关系结合起来的研究。方法：对来自英格兰和威尔士的97份洗浴水样进行了大肠杆菌携带bla（CTX-M）比例分析。这些数据被用来估计用水者摄入含有bla（CTX-M）的大肠杆菌的可能性。在确定冲浪者有暴露于ARB的风险后，进行了一项横断面研究。研究人员招募了经常冲浪者和不冲浪者，以评估冲浪和携带bla（CTX-M）的大肠杆菌在肠道定植之间是否存在关联。结果：97份洗浴水中11份检出含bla（CTX-M）大肠杆菌。虽然洗澡水中含有bla（CTX-M）的大肠杆菌的百分比很低（0.07%），但用水者有摄入这些ARB的风险。据估计，2015年发生的250多万次水上运动导致摄入至少一种含bla（CTX-M）的大肠杆菌。在流行病学调查中，9/143（6.3%）的冲浪者感染了携带bla（CTX-M）的大肠杆菌，而2/130（1.5%）的非冲浪者感染了bla（CTX-M）大肠杆菌（风险比= 4.09,95% CI 1.02 ~ 16.4, p=0.046）。结论：冲浪者在沿海水域有暴露于临床重要的耐抗生素大肠杆菌并被其定植的风险。必须对自然环境在ARB传播中所起的作用进行进一步研究。
Background: Antibiotic-resistant bacteria (ARB) present a global public health problem. With numbers of community-acquired resistant infections increasing, understanding the mechanisms by which people are exposed to and colonised by ARB can help inform effective strategies to prevent their spread. The role natural environments play in this is poorly understood. This is the first study to combine surveillance of ARB in bathing waters, human exposure estimates and association between exposure and colonisation by ARB in water users.Methods: 97 bathing water samples from England and Wales were analysed for the proportion of E. coli harbouring bla(CTX-M). These data were used to estimate the likelihood of water users ingesting bla(CTX-M)-bearing E. coli. Having identified surfers as being at risk of exposure to ARB, a cross-sectional study was conducted. Regular surfers and non-surfers were recruited to assess whether there is an association between surfing and gut colonisation by bla(CTX-M)-bearing E. coli.Results: 11 of 97 bathing waters sampled were found to contain bla(CTX-M)-bearing E. coli. While the percentage of bla(CTX-M)-bearing E. coli in bathing waters was low (0.07%), water users are at risk of ingesting these ARB. It is estimated that over 2.5 million water sports sessions occurred in 2015 resulting in the ingestion of at least one bla(CTX-M)-bearing E. coli. In the epidemiological survey, 9/143 (6.3%) surfers were colonised by bla(CTX-M)-bearing E. coli, as compared to 2/130 (1.5%) of non-surfers (risk ratio = 4.09, 95% CI 1.02 to 16.4, p=0.046).Conclusions: Surfers are at risk of exposure to and colonisation by clinically important antibiotic-resistant E. coli in coastal waters. Further research must be done on the role natural environments play in the transmission of ARB.