摘要
      抗微生物耐药性（AMR）在人类、动物和环境中循环，需要“一个健康”的方法。最近，城市污水越来越多地被认为是AMR的热点，即使在水卫生和个人卫生基础设施发达的高收入国家也是如此。为了了解HIC废水中AMR的现状，我们从已发表的文献中回顾了日本污水环境中AMR流行病学研究。我们的综述表明，在日本的人类废水中存在各种临床上重要的抗生素耐药性细菌（ARB）、抗生素耐药性基因（ARGs）和抗生素残留。它们的浓度低于中低收入国家，并在排放前被污水处理厂进一步降低。然而，剩余的ARB和ARG可能是河水中AMR污染的重要来源。此外，医院流出物可能是临床上重要ARB的重要来源。日本通常规定的高浓度抗微生物剂可能有助于AMR在废水中的选择和传播。我们的综述表明了监测人类废水中AMR和抗菌药物的重要性，以及减少其在废水中污染负荷的努力。
Abstract
Antimicrobial resistance (AMR) circulates through humans, animals, and the environments, requiring a One Health approach. Recently, urban sewage has increasingly been suggested as a hotspot for AMR even in high-income countries (HICs), where the water sanitation and hygiene infrastructure are well-developed. To understand the current status of AMR in wastewater in a HIC, we reviewed the epidemiological studies on AMR in the sewage environment in Japan from the published literature. Our review showed that a wide variety of clinically important antibiotic-resistant bacteria (ARB), antibiotic resistance genes (ARGs), and antimicrobial residues are present in human wastewater in Japan. Their concentrations are lower than in low- and middle-income countries (LMICs) and are further reduced by sewage treatment plants (STPs) before discharge. Nevertheless, the remaining ARB and ARGs could be an important source of AMR contamination in river water. Furthermore, hospital effluence may be an important reservoir of clinically important ARB. The high concentration of antimicrobial agents commonly prescribed in Japan may contribute to the selection and dissemination of AMR within wastewater. Our review shows the importance of both monitoring for AMR and antimicrobials in human wastewater and efforts to reduce their contamination load in wastewater.

https://www.mdpi.com/2079-6382/11/7/849