Catchment-scale processes contributing to transmission of antibiotic resistance in bathing waters

致病细菌在旨在杀死它们的抗生素存在下生存和生长的能力（抗生素耐药性）已被描述为对人类的最大威胁之一。这一威胁不仅对人类健康构成威胁，也对动植物健康构成威胁。它将通过增加治疗费用、延长住院时间以及提高发病率和死亡率，对经济产生重大影响。抗生素耐药性的增加也将导致经济生产力的损失。在世界银行2017年关于耐药感染对全球经济的破坏性影响的报告中，他们建议，应对耐药感染的关键是采取行动，并在以下部门进行投资：卫生、农业、城市发展、水和卫生。在这项研究中，我将与供水和卫生行业（西南供水）的一位代表合作进行研究，这将与许多这些部门相关。我的目标是使用尖端技术来估计沐浴水中抗生素耐药细菌的丰度，这些细菌受到各种污染源（包括废水处理厂和农业）的影响。我还将调查在这些关键环境中导致抗生素耐药细菌向人类传播的集水区水平过程。洗澡水是许多公众密切接触的水生环境，可能会接触到高水平的耐药细菌。我之前的研究表明，在英国，每年有数百万人暴露于一种临床上重要的耐药大肠杆菌。拟议的研究将侧重于一种关键指示细菌大肠杆菌的所有耐药机制，该细菌在英国所有指定的浴场海滩进行量化，从而可以对人类暴露进行定量风险评估。通过了解耐药性增强的原因，从而增加接触风险，我们可以为减少微生物污染的缓解战略提供信息。本研究结果对于识别和了解抗生素耐药性的来源和传播具有全球意义。这些发现不仅具有学术意义，而且拟议的研究所产生的信息也有助于为区域和国家一级关于土地和水管理的讨论提供信息。此外，本研究产生的信息将为水行业应对新出现的环境抗菌素耐药性问题提供宝贵的知识。改进的处理方法极其昂贵和能源密集，对社会造成的后果是水费增加和温室气体排放增加。公众对这些问题非常关注。如果没有充分的证据证明水工业对这些问题的贡献和可能的解决办法，或者对人类健康构成的风险程度，就没有什么动力设计和投资创新的解决办法，以减少抗生素耐药细菌向接收水的传播。

The ability of disease-causing bacteria to survive and grow in the presence of antibiotics designed to kill them (antibiotic resistance) has been described as one of the greatest threats to humans. This threat not only poses a risk to human health, but also to animal and plant health. It will have significant impacts on the economy through increased cost of treatment, longer hospital stays, and higher rates of morbidity and mortality. Increasing antibiotic resistance will also result in loss of economic productivity. In the World Bank's 2017 report on the devastating effect of drug-resistant infections on the global economy, they recommended that the key to tackling resistant infections should be to take action and make investments in the following sectors: Health, Agriculture, Urban Development, and Water and Sanitation. In this fellowship, I will conduct research, in collaboration with a representative of the Water and Sanitation Industry (South West Water), that will be relevant for many of these sectors. I aim to use cutting-edge technology to estimate the abundance of antibiotic resistant bacteria in bathing waters, which are impacted by various pollution sources (including those from wastewater treatment plants and agriculture). I will also investigate catchment-level processes which contribute to the transmission of antibiotic resistant bacteria to humans in these key environments. Bathing waters represent aquatic environments which many members of the public come into close contact with, leading to potential exposure to high levels of resistant bacteria. My previous research suggests that there are millions of human exposure events to one type of clinically important resistant Escherichia coli per year in UK bathing waters. The proposed research will focus on all resistance mechanisms in a key indicator bacterium, E. coli, which is quantified at all designated bathing beaches in the UK, allowing quantitative risk assessment of human exposure to be undertaken. By understanding the reasons for increased resistance and therefore increasing exposure risk, we can inform mitigation strategies for reducing microbial pollution. The results of this research have global significance in terms of identifying and understanding the sources and transmission of antibiotic resistance. Not only will the findings be of academic interest but the information generated by the proposed research can help inform discussions about land and water management at both regional and national levels. In addition, the information generated by this research will contribute valuable knowledge to inform the water industry's response to the emerging problem of environmental antimicrobial resistance. Enhanced treatment methods are extremely costly and energy intensive, with consequences for society through higher water bills and greater greenhouse gas emissions. There is much public concern about these matters. Without sufficient evidence of the water industry's contribution to the problems and possible solutions, or of the degree of risk posed to human health, there is little incentive to devise and invest in innovative solutions to reduce the dissemination of antibiotic resistant bacteria to receiving waters.