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

抗菌药耐药性(ABR)是对健康和发展的全球性威胁，而且这个问题正在变得越来越严重。在拉丁美洲，阿根廷自1986年以来一直在跟踪人类感染中的ABR水平。阿根廷也是该区域第一个制定控制ABR的国家战略的国家。这项国家战略采取了令人震惊的假设，即在畜牧业中使用抗菌药物(ABS)在一定程度上要对ABR对人类的威胁负责。在农场使用ABS可能通过3条主要途径导致ABR人类感染：(1)在农场环境中选择的ABR细菌感染人类，或至少其中携带的可移动的ABR基因被传递给感染人类的细菌；(2)食品中的农业AB残留被人类摄入，在人类细菌中选择ABR；(3)农业ABS污染非农业环境，在细菌中选择ABR，然后感染人类。在阿根廷，农场和附近农场环境中ABR细菌数量的数据极其有限。此外，虽然对进入正式市场的食品中的AB残留进行了监测，但存在一个重要的非正式市场，而且环境中的AB水平没有得到常规测量。应对ABR日益增长的威胁的一个潜在对策是监管，以世卫组织为首的国际组织和个别国家都试图制定新的监管框架，例如解决农业中ABR的使用和使用问题，以及农业废物的管理。然而，正如O‘Neill报告所承认的那样，发展中国家“……将需要额外的支持和额外的时间来培训兽医、制定法规、建立监督能力和改进耕作方法”。FARMS-SAFE项目的前提是，除了为ABR和AB的使用提供更好的监测信息外，对阿根廷和其他拉丁美洲国家的额外支持也应该遵循基于风险的方法来设计监管以及加强执法能力；它们的弱点是另一个风险来源。FARMS-SAFE将通过英国/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.动物疾病是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。畜牧业做法是ABR风险的驱动因素-我们将确定哪些农场管理做法影响ABS的使用，并将对阿根廷农场使用ABS的情况进行监控。农业废物管理是ABR风险的驱动因素。我们将在附近农场环境中对具有明显潜在影响人类健康的ABR细菌进行监测，并将测量附近农场环境中ABS和其他化学品的水平。我们将把ABR与AB的使用情况关联起来，并确定环境中ABR和AB污染的管理风险因素。监管能力是ABR风险的驱动因素。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监管的工具，以获得推动ABR的风险的信息。这项工作将使人们对ABR在阿根廷农业系统中的流行和原因有重要的新理解，这将如何影响近农场环境(从而潜在影响人类健康)，并将为阿根廷、拉丁美洲和更广泛的世界的决策提供信息。我们还将创建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的使用情况以及ABS和ABR对环境的污染，并能够衡量为降低这一风险而采取的策略的成败。

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.