Abstract：
Antimicrobial resistance (AMR) is one of the most significant global health threats. Inappropriate and over-usage of antimicrobial agents (AAs) is a major driver for AMR. Wastewater-based epidemiology (WBE) is a promising tool for monitoring AA usage in communities which is, for the first time, explored in this large scale, longitudinal study. Two contrasting urban catchment areas have been investigated: one city and one small town in the Southwest of the UK over a 13-month period in 2018-2019. Per capita daily intake of 17 AAs and metabolites has been estimated and obtained estimates were triangulated with catchment specific AA prescription data to understand AA usage patterns (both seasons driven prescription and AA prescription compliance). Results have demonstrated positive correlations for all quantifiable parent AAs and metabolites in wastewater, and spatial variability in AA usage was observed even in neighbouring urban areas. WBE and catchment specific prescription data showed similar seasonal trends but with low correlation in intake. The reasons might be variable prescribing patterns, prescription/intake outside the studied catchment, and/or lack of patient compliance. WBE proved useful in differentiating between consumption vs topical usage and/or direct disposal of unused AA. WBE is considered superior to prescription data as it provides information on AAs prescribed outside of the monitoring catchment, e.g. HIV antivirals and TB drugs. However, data triangulation, of both prescription data and wastewater data, provides the most comprehensive approach to understanding AA usage in communities.
摘要：
抗菌素耐药性(AMR)是全球最重要的健康威胁之一。抗微生物剂(AAs)的不适当和过度使用是AMR的主要驱动因素。基于废水的流行病学（WBE）是监测社区AA使用情况的有前途的工具，第一次,在如此大规模的探索中，纵向研究。已经调查了两个截然不同的城市集水区：2018-2019年的13个月期间，英国西南部的一个城市和一个小镇。已估计了人均每日17种AA和代谢物的摄入量，并使用特定于流域的AA处方数据对获得的估计值进行了三角测量，以了解AA的使用方式（季节驱动的处方和AA处方的合规性）。结果表明，废水中所有可量化的母体AA和代谢物均呈正相关，即使在邻近的城市地区，也观察到AA使用的空间变异性。WBE和流域特定处方数据显示出相似的季节性趋势，但摄入量相关性较低。原因可能是不同的处方模式，所研究集水区外的处方/摄入量，和/或缺乏患者依从性。WBE被证明可用于区分消费与局部使用和/或直接处置未使用的AA。WBE被认为优于处方数据，因为它提供了监测集水区以外规定的AA的信息。例如HIV抗病毒药物和结核病药物。然而,数据三角剖分,处方数据和废水数据，提供了最全面的方法来了解社区中的AA使用情况。
