DRIVERS OF HUMAN EXPOSURE TO ANTIBACTERIAL RESISTANCE IN THE SRI LANKAN ENVIRONMENT

越来越多的证据表明，自然环境（即废水系统、土壤、地表沃茨和地下沃茨）中抗菌剂、其他环境污染物和抗菌剂耐药性基因的存在间接影响人类和动物的健康，并导致全球抗菌剂耐药性问题。抗菌药物、其他选择压力和耐药基因向环境的释放将来自许多来源，包括抗菌药物生产场所、医院和诊所、畜牧设施和家庭。一旦进入环境，这些污染物可能会持续存在或消散，并将分布在不同的环境分区。然后，人类和动物可以通过以下方式暴露于抗菌化合物和耐药生物体：呼吸灰尘;食用受污染的饮用水，植物，肉类，鱼类和贝类;通过娱乐和洗浴活动;以及通过与野生动物接触。暴露水平将由一系列文化、社会经济、健康和环境驱动因素驱动。在欧洲和北美地区，美国有高度管制的集中废水处理和优质的水，环境暴露和抗菌化合物和耐药基因的发生可能在一定程度上得到控制。然而，在快速发展的经济体和废水处理连通性较低的地区，抗菌素和抗生素耐药性污染的问题可能更为严重。鉴于自然环境中抗菌药物和耐药基因在总体耐药性水平上的发生越来越多的证据基础，迫切需要了解自然环境对低收入至中等收入国家（LMIC）问题的贡献及其背后的驱动因素。在这个项目中，我们将汇集卫生从业人员，环境科学家，微生物学家，建模人员和社会科学家，以开发，参数化和验证一个空间框架，用于模拟斯里兰卡环境中抗菌物质和抗生素耐药性基因的发生以及随后人类暴露于这些环境。该框架将评估一系列发生和暴露驱动因素的影响，包括抗菌剂的生产和使用、土地使用和自然环境的特征。通过汇集这些信息，我们将能够确定全国范围内发生和暴露的“热点”，这将使未来的干预措施能够针对导致最高暴露风险的情景和做法。在项目中，我们将重点关注斯里兰卡的情况，项目中开发的知识、工具和流程将与其他LMIC相关。为期8个月的开发阶段项目将结合联合收割机数据和文献审查活动、研讨会和利益相关者活动，以开发斯里兰卡环境中AMR暴露的概念模型，并建立数据集的可用性，以参数化模型。因此，该项目的这一阶段将更好地确定整个项目阶段的工作方案，并确定对斯里兰卡抗菌素耐药性问题感兴趣的关键利益攸关方的需求。发展阶段的一个关键组成部分将是建立一个跨学科和跨部门的伙伴关系，包括来自斯里兰卡，英国和其他地方的领先组织。

There is a growing evidence-base that the presence of antibacterials, other environmental pollutants and antibacterial resistance genes in the natural environment (i.e. wastewater systems, soils, surface waters and groundwaters) is indirectly affecting human and animal health and contributing to the global antibacterial resistance problem. The release of antibacterials, other selection pressures and resistance genes to the environment will occur from a number of sources including antibacterial manufacturing sites, hospitals and clinics, livestock facilities and from households. Once in the environment these contaminants may persist or dissipate and will be distributed around the different environmental compartments. Humans and animals can then be exposed to the antibacterial compounds and resistant organisms through: the breathing of dust; consumption of contaminated drinking water, plants, meat, fish and shellfish; through recreational and bathing activities; and via contact with wildlife. The level of exposure will be driven by a range of cultural, socio-economic, health and environmental drivers. In areas of Europe and N. America with highly regulated, centralised wastewater treatment and good quality water, the environmental exposure and occurrence of antibacterial compounds and resistance genes is likely to be controlled to some degree. However, the issue of antibacterial and antibiotic resistance pollution is likely to be much more acute in rapidly developing economies and areas with lower wastewater treatment connectivity. Given the increasing evidence-base for the occurrence of antibacterials and resistance genes in the natural environment on overall resistance levels, there is an urgent need to understand the contribution of the natural environment to the problem, and the drivers behind this, in low to middle income countries (LMICs). In this project, we will bring together health practitioners, environmental scientists, microbiologists, modellers and social scientists to develop, parameterise and validate a spatial framework for modelling the occurrence of antibacterial substances and antibiotic resistance genes in the environment of Sri-Lanka and the subsequent exposure of the human populations to these. The framework will characterise the impacts of a range of drivers of occurrence and exposure including antibacterial manufacturing and use, land-use and the characteristics of the natural environment. By bringing this information together, we will be able to identify 'hotspots' of occurrence and exposure across the country which will allow future interventions to be targeted at scenarios and practices resulting in the highest risk of exposure. While in the project we will focus on the Sri Lankan situation, the knowledge, tools and processes developed in the project will be relevant to other LMICs.The 8-month development phase project will combine data and literature review activities, workshops and stakeholder events to develop a conceptual model for AMR exposure in the environment of Sri Lanka and to establish the availability of data sets to parameterise the model. This phase of the project will therefore better define the work programme of the full project phase and identify the needs of key stakeholders with an interest in the problem of antibacterial resistance in Sri Lanka. A key component of the development phase will be the establishment of an interdisciplinary and intersectoral partnership comprising leading organisations from Sri Lanka, the UK and elsewhere.