Antimicrobial Stewardship in Hospitals, Resistance Selection and Transfer in a One Health Context

STRESST项目（医院抗菌药物管理，单一健康环境下的耐药性选择和转移）将确定医院范围内的抗菌药物管理对抗生素数量的影响，以及医院废水中释放的敏感和耐药细菌的数量。这些数据将显示管理是否可以减少进入环境的抗生素和耐药细菌的数量。医院废水也可能代表抗生素耐药细菌选择的热点。我们将确定存在的抗生素是否可以催化携带抗生素耐药基因的移动的遗传元件的细胞内转座和细胞间结合，以及在抗菌药物管理干预后是否不太可能发生这种情况。除了基于琼脂平板的测定外，这些实验还将包括最先进的动物盲肠发酵罐模型，该模型将医疗保健环境（医院）与更广泛的环境（通过医院废水）和动物健康直接联系起来，代表所有三个One Health领域。最终，STRESST项目将证明抗菌剂管理在减少抗生素和抗生素耐药性细菌释放到环境中方面的有效性，以及这如何影响将其用作水源的动物中存在的微生物群落内部和之间的耐药性传播。在一个健康的背景下，耐药性传播的整体观点将有助于突出未来干预措施的选择热点（医院废水）。

The STRESST project (Antimicrobial Stewardship in Hospitals, Resistance Selection and Transfer in a One Health Context) will determine the effects of hospital-wide antimicrobial stewardship on the amount of antibiotics, and the numbers of susceptible and resistant bacteria, released in hospital wastewater. This data will show if stewardship can reduce the amounts of antibiotics and resistant bacteria entering the environment. Hospital wastewater is also likely to represent a hotspot for selection of antibiotic resistant bacteria. We will determine if the antibiotics present can catalyse both intracellular transposition and intercellular conjugation of mobile genetic elements carrying antibiotic resistance genes, and if this is less likely to occur following the antimicrobial stewardship intervention. In addition to agar plate-based assays, these experiments will also include state of the art animal caecum fermenter models which will directly link the healthcare environment (hospital) with the wider environment (via hospital wastewater) and animal health representing all three One Health areas. Ultimately, the STRESST project will demonstrate the effectiveness of antimicrobial stewardship in reducing antibiotic, and antibiotic resistant bacteria, release into the environment and how this impacts resistance transmission within and between microbial communities present in animals that use this as a water source. This holistic view of resistance transmission within a One Health context will serve to highlight a selection hotspot (hospital wastewater) for future interventions.