摘要
      抗菌药物被归类为令人担忧的紧急微污染物，这意味着即使在低浓度下，长期暴露在环境中也会产生显著的生态毒理学影响。缺乏一个标准化的监管框架来管理用于监测环境水质标准的允许抗生素含量。因此，不分青红皂白地向城市污水处理设施排放具有潜在活性浓度的抗菌药物的现象十分猖獗。抗菌药物可能对细菌施加选择性压力，导致耐药性的发展和最终的健康后果。在未经处理的医院废水和废水处理厂（WWTP）中出现具有临床意义的多重抗生素耐药性细菌与细菌持续暴露于抗菌药物有关。需要阐明抗生素的环境暴露水平及其与耐药细菌进化和传播的相关性，以帮助制定缓解措施。这篇综述探讨了废水中经常检测到的抗菌药物，并通过表达各种抗生素耐药性基因，全面涵盖了细菌对不同抗生素类的耐药性机制，这些抗生素耐药性基因要么是细菌固有的和/或在细菌之间交换的，要么是从废水系统中的抗生素耐药性基因库中获得的。为了补充从WWTP中去除抗生素和ARGs，扩大实施前瞻性干预措施，如疫苗、噬菌体疗法和天然化合物，作为广泛使用抗生素的替代品，为最大限度地减少抗微生物耐药性的传播提供了一种多方面的方法。
Abstract
Antimicrobial pharmaceuticals are classified as emergent micropollutants of concern, implying that even at low concentrations, long-term exposure to the environment can have significant eco-toxicological effects. There is a lack of a standardized regulatory framework governing the permissible antibiotic content for monitoring environmental water quality standards. Therefore, indiscriminate discharge of antimicrobials at potentially active concentrations into urban wastewater treatment facilities is rampant. Antimicrobials may exert selective pressure on bacteria, leading to resistance development and eventual health consequences. The emergence of clinically important multiple antibiotic-resistant bacteria in untreated hospital effluents and wastewater treatment plants (WWTPs) has been linked to the continuous exposure of bacteria to antimicrobials. The levels of environmental exposure to antibiotics and their correlation to the evolution and spread of resistant bacteria need to be elucidated to help in the formulation of mitigation measures. This review explores frequently detected antimicrobials in wastewater and gives a comprehensive coverage of bacterial resistance mechanisms to different antibiotic classes through the expression of a wide variety of antibiotic resistance genes either inherent and/or exchanged among bacteria or acquired from the reservoir of antibiotic resistance genes (ARGs) in wastewater systems. To complement the removal of antibiotics and ARGs from WWTPs, upscaling the implementation of prospective interventions such as vaccines, phage therapy, and natural compounds as alternatives to widespread antibiotic use provides a multifaceted approach to minimize the spread of antimicrobial resistance.

https://link.springer.com/article/10.1007/s11274-022-03334-0