FARMS-SAFE: Future-proofing Antibacterial resistance Risk Management Surveillance and Stewardship in the Argentinian Farming Environment

抗菌药物耐药性（ABR）是一个全球性的健康和发展威胁，并且是一个日益严重的问题。在拉丁美洲，阿根廷自1986年以来一直在跟踪人类感染的ABR水平。阿根廷也是该地区第一个制定国家战略控制ABR的国家。这项国家战略采取了一个起始假设，即在畜牧业中使用抗菌药物（ABs）是人类ABR威胁的部分原因。在农场使用AB可能通过3种主要途径导致ABR人类感染：（1）在农场环境中选择的ABR细菌感染人类，或至少携带的移动的ABR基因传播给感染人类的细菌;（2）食物中的农业AB残留被人类摄入，选择人类细菌中的ABR;（3）农业ABs污染非农业环境，选择细菌中的ABR，然后感染人类。在阿根廷，关于农场和农场附近环境中ABR细菌数量的数据非常有限。此外，虽然对进入正规市场的食品中的AB残留物进行了监测，但存在大量的非正规市场，环境中的AB水平没有进行常规测量。对ABR威胁的一个潜在应对措施是监管，以WHO为首的国际组织和个别国家都试图制定新的监管框架，以解决农业中ABs的使用和农业废物的管理问题。然而，正如奥尼尔的报告所承认的那样，发展中国家“.将需要额外的支持和时间来培训兽医，制定法规，建立监督能力和改善养殖实践。这一项目- FARMS-SAFE -的前提是，除了为ABR和AB的使用提供更好的监督信息外，对阿根廷和其他拉丁美洲国家的额外支持还应包括在制定规章和加强执法能力方面采取基于风险的办法;他们的弱点是另一个风险来源。FARMS-SAFE将通过一个英国/阿根廷研究联盟参考四个关键风险领域来解决这个问题：1.动物疾病作为ABR风险的驱动因素-我们将确定为什么农民在动物疾病的背景下使用ABs。畜牧业实践作为ABR风险的驱动因素-我们将确定正在采用哪些农场管理实践影响ABs的使用，并将在阿根廷的农场对ABs的使用进行监测。农业废弃物管理是ABR风险的驱动因素。我们将在农场附近的环境中对具有明显影响人类健康潜力的ABR细菌进行监测，并将测量农场附近环境中ABs和其他化学品的水平。我们将把ABR与AB的使用联系起来，并将识别环境中ABR和AB污染的管理风险因素.作为ABR风险驱动因素的监管能力。我们将确定参与ABR监管的关键个人和组织，并与他们合作开发可用于以驱动ABR的风险为信息的方式进行监管的工具。这项工作将导致对阿根廷农业系统中ABR的流行和原因的重要新理解，这将如何影响农场附近的环境（从而潜在地影响人类健康），并将为阿根廷、拉丁美洲和更广泛的世界的政策制定提供信息。我们还将建立一个监测结构和训练有素的研究人员，他们可以在未来继续监测ABR、AB的使用和AB和ABR的环境污染，并可以衡量为降低这种风险而采用的策略的成功和失败。

Antibacterial drug resistance (ABR) is a global threat to health and development and a problem that is getting steadilyworse. Within Latin America, Argentina has been tracking levels of ABR in human infections since 1986. Argentina wasalso the first country in the region to develop a national strategy for the control of ABR. This national Strategy takes astarting assumption that the use of antibacterial drugs (ABs) in livestock agriculture is in part responsible for the threatof ABR in humans. The use of ABs on farms can potentially result in ABR human infections via 3 main pathways: (1)ABR bacteria selected in the farm environment infect humans, or at least the mobile ABR genes carried within themare transmitted to bacteria that infect humans; (2) Agricultural AB residues in food are ingested by humans, selectingfor ABR in human bacteria; (3) Agricultural ABs contaminate the non-farm environment, selecting ABR in bacteriathere, which then infect humans. In Argentina, data are extremely limited for the amount of ABR bacteria on farmsand in the near-farm environment. Furthermore, whilst AB residues are monitored in foodstuffs entering the formalmarket, there is a significant informal market, and AB levels in the environment are not routinely measured. Onepotential response to the rising threat of ABR is regulation, and both international organizations - led by the WHO -and individual countries have sought to formulate, for example, new regulatory frameworks to address the and use ofABs in farming, as well as the management of farm waste. As the O'Neill report recognises, however, developingcountries "...will need extra support and additional time to train veterinarians, develop regulations, build surveillancecapacity and improve farming practices". The premise of this project - FARMS-SAFE - is that as well as providing bettersurveillance information for ABR and AB usage, extra support for Argentina and other Latin American countries shouldencompass a risk-based approach to the design of regulation as well as to the strengthening of enforcement capacities;their weakness is another source of risk.FARMS-SAFE will address this issue by reference to four key risk areas via an UK/Argentinian research consortium:1. Animal disease as a driver of ABR risk - We will identify why farmers use ABs in the context of animal disease.2. Animal husbandry practice as a driver of ABR risk - We will identify what farm management practices are beingemployed that influence the usage of ABs and will perform surveillance of the usage of ABs on farms in Argentina.3. Farm waste management as a driver of ABR risk. We will perform surveillance of ABR bacteria with clearpotential to affect human health on farms in the near farm environment and will measure the levels of ABs and other chemicals in the near-farm environment. We will correlate ABR with AB usage and will identify management riskfactors for ABR and AB contamination in the environment.4. Regulatory capacity as a driver of ABR risk. We will identify the key individuals and organisations involved inregulation of ABR and work with them to develop tools that can be used to regulate in a way that is informed by therisks that drive ABR.This work will lead to significant new understanding of the prevalence and causes of ABR in Argentinian farmingsystems, how this influences the near-farm environment (and so potentially influences human health) and will informpolicy making within Argentina, Latin America and the wider world. We will also create a surveillance structure andtrained researchers who can continue to monitor ABR, AB usage and environmental contamination with ABs and ABRinto the future, and who can measure success and failure of strategies employed to reduce this risk.