The environmental dimension of antimicrobial resistance: informing policy, regulation and practice.

抗菌素耐药(AMR)是指由细菌等病原体引起的感染治疗失败的现象。首席医疗官Dame Sally Davies教授将AMR构成的威胁与气候变化和全球恐怖主义相提并论。如果目前的趋势继续下去，估计到2050年，AMR感染将成为主要的死亡原因，累计给社会造成100万亿美元的损失。这项知识交流奖学金的重点是细菌的AMR，特别是环境在增加临床病原体耐药性方面的作用。AMR是古老的，在数百万年或数十亿年的时间里在环境细菌中进化。随着进化时间的推移，抗性机制已经通过一种被称为水平基因转移的过程从环境细菌动员到人类病原体。在受人类和动物排泄物影响的环境中，AMR水平很高，众所周知，在沿海洗澡水域等环境中，暴露于AMR细菌的风险很大。然而，环境暴露和传播的相对重要性目前还不确定，为政策和法规提供信息所需的证据的性质也是不确定的。该KE奖学金旨在促进学术界、政府和行业之间关于环境AMR的知识交流，目的是为政策制定、监管、缓解和减少风险战略提供信息。由于联合国和世卫组织等组织迅速将这一主题领域的知识交流列为优先事项，而且未来可能会加强监管，因此Defra、环境局(EA)和工业界对此领域的知识交流有需求。环境保护局和环境保护局是政策制定和监管机构，负责审议与环境中的AMR有关的证据，并与制药和水行业一样，是关键合作伙伴。还将与更广泛的利益攸关方进行知识交流，例如，保险业关注与AMR环境传播相关的潜在责任。将与Defra、EA、制药和水行业进行一系列互惠的知识交流，重点关注由环境污染驱动的AMR的演变、AMR的景观规模传播和环境向人类的传播。这三个领域是由Gaze博士实验室内的多个研究项目涵盖的，由于他的研究范围包括三个跨理事会倡议AMR赠款，他在完成知识交流活动方面处于独特的地位。他的研究小组是国际上研究这一主题的最大小组之一。他曾为英国政府和联合国提供咨询，并与制药和水务行业有着密切的联系。将在研究金的开始、中期和结束时举办三个讲习班，分别确定知识的优先次序、评估进展情况和提出政策建议。一个环境AMR网络将与一个网站一起建立，该网站提供该网络的资源和关于每个科学问题的数据。一项关键活动将是与环境保护局合作制定环境监测方案和目标，因为目前的努力主要基于研究，由于每个实验室使用不同的方法，因此不具有可比性。这是Defra和EA的一个关键目标，他们提供了大量的时间来通过这一奖学金与学术界共同制定监测战略。产出将包括由所有合作伙伴共同设计的政策建议，以及一份强调知识差距和当前政策执行障碍的报告和科学出版物。

Antimicrobial resistance (AMR) is the phenomenon that leads to treatment failure of infections caused by pathogenic organisms such as bacteria. The Chief Medical Officer Professor Dame Sally Davies has compared the threat posed by AMR to that of climate change and global terrorism. If current trends continue it is estimated that AMR infections will be the leading cause of death by 2050 with a cumulative cost to society of $100 trillion. This Knowledge Exchange Fellowship focuses on AMR in bacteria and specifically the role of the environment in increasing resistance seen in clinical pathogens. AMR is ancient, having evolved in environmental bacteria over millions or billions of years. Resistance mechanisms that evolved over evolutionary time have been mobilised from environmental bacteria to human pathogens through a process known as horizontal gene transfer. Levels of AMR are high in environments impacted by human and animal waste and it is known that significant exposure risk to AMR bacteria occurs in environments such as coastal bathing waters. However, the relative importance of environmental exposure and transmission is currently uncertain as is the nature of evidence required to inform policy and regulation.This KE Fellowship aims to facilitate knowledge exchange relating to AMR in the environment from, and between, academia, government and industry with the objective of informing policy making, regulation, mitigation and risk reduction strategies. There is demand from Defra, the Environment Agency (EA) and industry for knowledge exchange in this subject area due to its rapid prioritisation by organisations such as the UN and WHO and the probability that increased regulation may occur in the future. Defra and the EA are the policy making and regulatory agencies that are tasked with considering the evidence relating to AMR in the environment and are key partners as are the pharmaceutical and water industries. Knowledge exchange will also take place with a wider range of stakeholders, for example the insurance industry is concerned with potential liabilities associated with environmental transmission of AMR. A series of reciprocal knowledge exchange placements will take place with Defra, the EA, the pharmaceutical and water industries focusing on evolution of AMR driven by environmental pollution, land scape scale dissemination of AMR and environmental transmission to humans. These three areas are covered by multiple research projects within Dr Gaze's lab who is uniquely placed to fulfill Knowledge Exchange activities due to the scope of his research portfolio which includes three cross-council initiative AMR grants. His research group is one of the largest working on this subject internationally. He has advised UK government and the United nations and has strong links to the pharmaceutical and water industries. Three workshops will take place at the beginning, middle and end of the Fellowship to prioritise KE, assess progress and produce policy recommendations respectively. An environmental AMR network will be set up alongside a website with resources for the network and data on each of the scientific issues. A key activity will be to work with the EA to develop protocols and targets for environmental surveillance as current efforts are largely research based and are not comparable as each lab uses different methodologies. This is a key goal of Defra and the EA and they have offered significant time to co-develop a surveillance strategy with the academic community through this Fellowship. Outputs will include policy recommendations co-designed by all partners, and a report and scientific publication highlighting knowledge gaps and current barriers to policy implementation.