Antimicrobial resistance gene persistence in waste water treatment systems, the natural environment and patient samples in the Lothians

抗微生物药物耐药性对全球卫生服务构成重大威胁。虽然已知在医疗使用抗生素之前，环境中就存在含有抗微生物药物耐药性（AMR）基因的细菌，但它们的大量使用导致了AMR基因多样性和流行率的迅速增加。目前，关于不同环境因素如何影响AMR基因的流行和传播，还缺乏相关的知识。重要的是要进一步了解这些因素，因为这将有助于制定拦截和预防抗菌素耐药性传播来源的战略。抗生素的广泛治疗使用导致人类粪便中发现的抗微生物药物耐药性细菌水平增加，使废水处理厂成为耐药细菌的“热点”。向周围环境排放污水和在农业用地上使用生物固体作为肥料是耐药细菌及其抗微生物药物耐药性基因进入环境的一个重要入口。目前的项目旨在提高我们对抗菌素耐药性基因在污水处理厂和环境中流行和持续存在的影响因素的理解。已经编制了一份针对已知抗性基因的引物清单，该研究将对其进行测试并用于聚合酶链反应（PCR），以调查一系列样品中各种AMR基因的丰度。除了世界污水处理厂，还将从包括农业用地和农村/城市地区在内的多种环境中采集土壤和水样，以评估人类活动对抗菌素耐药性流行的影响。该研究还将利用实验室规模的生物反应器和微观环境，反映现实世界的污水处理量和环境，研究影响临床相关AMR基因随时间的持久性的因素，以及它们在不同条件下在微生物群落中的流行程度。这可能包括污水处理厂中使用的操作条件。该项目将探索的另一个领域旨在提高我们对环境在临床相关抗菌素耐药性基因向人类传播中的作用的理解。这将通过对从爱丁堡健康人类志愿者收集的粪便样本进行PCR来解决。AMR基因的丰度将与环境样本中观察到的丰度进行比较，以确定是否存在任何相关性。这将有助于建立一个更清晰的画面，详细说明环境中的抗菌素耐药性基因对人类的影响程度。

Antimicrobial resistance poses a major threat to health services on a global scale. Whilst bacteria harbouring antimicrobial resistant (AMR) genes are known to have existed in the environment preceding the medical use of antibiotics, their intensive use has resulted in a rapid increase in AMR gene diversity and prevalence. Currently, there is a lack of knowledge surrounding how different environmental factors influence the prevalence and dispersal of AMR genes. It is important to gain greater understanding these factors as it will enable the development of strategies to intercept and prevent sources of AMR spread. The extensive therapeutic use of antibiotics has resulted in an increase in the level of antimicrobial resistant bacteria found in human faeces, making waste water treatment plants (WWTPs) a "hotspot" of resistant bacteria. The release of effluent into the surrounding environment and the use of biosolids as a fertiliser on agricultural land act as a significant point of entry for resistant bacteria and their AMR genes into the environment. The current project aims to improve our understanding of the contributing factors to the prevalence and persistence of AMR genes in WWTPs and in the environment. A list of primers targeting known resistance genes has been compiled, which the study will test and use in polymerase chain reaction (PCR) to investigate the abundance of a variety of AMR genes in a range of samples. Alongside the WWTP, soil and water samples will be taken from a diverse set of environments including agricultural land and rural/ urban areas, in order to assess the impact of human activity on AMR prevalence. The study will also utilize lab-scale bioreactors and microcosms, reflecting real-world WWTPs and environments to investigate factors influencing the persistence of a select number of clinically relevant AMR genes over time and their prevalence amongst microbial communities under differing conditions. This may include operating conditions used in WWTPs. Another area the project will explore aims to increase our understanding regarding the role of the environment in the transmission of clinically relevant AMR genes to the human population. This will be addressed by performing PCR on faecal samples collected from healthy human volunteers in Edinburgh. The abundance of AMR genes will be compared to those observed in the environmental samples, in order to establish whether there is any correlation. This will help build a clearer picture detailing the extent to which AMR genes in the environment impact the human population.