北欧国家(丹麦,芬兰,冰岛,挪威,和瑞典)有效地保持了比许多国家更低的抗生素抗性细菌(ARB)病原体率。然而,这些国家正在努力应对ARB病例的增加以及由于ARB病原体的流行而在治疗感染方面面临的挑战.废水监测(WBS)是ARB监测临床方法的宝贵补充,但北欧国家对WBS申请ARB缺乏全面的了解。这篇综述旨在汇编北欧国家用于ARB监测的WBS的最新发展,并将其与临床监测实践进行比较。在审查了初级搜索的1480篇论文后,54人被发现相关,另外还包括15篇与WBS相关的论文。在分析的69项研究中,42专门的临床流行病学,而27人专注于废水监测。PRISMA对文献的回顾表明,北欧国家专注于AMR的四个主要WBS目标:评估人口中的AMR,识别AMR逃避废水处理,量化去除率,并评估潜在的AMR演变。在临床和废水环境中,研究最多的目标是产生碳青霉烯酶和超广谱β-内酰胺酶(ESBL)的病原体,主要是大肠杆菌和克雷伯菌属。然而,耐万古霉素肠球菌(VRE)和耐甲氧西林金黄色葡萄球菌(MRSA)在临床流行病学中受到了比废水研究更多的关注,可能是由于它们在废水中的检出率较低。临床监测主要使用培养,抗生素药敏试验,和基因分型,但是WBS采用了基于PCR和宏基因组学以及基于培养的技术。国际旅行和国外住院导致的进口病例似乎经常导致这些国家ARB病原体病例的增加。北欧国家之间的许多相似之处(例如,知识交流实践,抗生素的使用模式,和当前的ARB景观)可以促进在人口水平筛查中制定和实施ARBWBS的合作努力。
The
Nordic countries (Denmark, Finland, Iceland, Norway, and Sweden) have effectively kept lower antibiotic-resistant bacterial (ARB) pathogen rates than many other countries. However, in recent years, these five countries have encountered a rise in ARB cases and challenges in treating infections due to the growing prevalence of ARB pathogens. Wastewater-based surveillance (WBS) is a valuable supplement to clinical methods for ARB surveillance, but there is a lack of comprehensive understanding of WBS application for ARB in the
Nordic countries. This review aims to compile the latest state-of-the-art developments in WBS for ARB monitoring in the
Nordic countries and compare them with clinical surveillance practices. After reviewing 1480 papers from the primary search, 54 were found relevant, and 15 additional WBS-related papers were included. Among 69 studies analyzed, 42 dedicated clinical epidemiology, while 27 focused on wastewater monitoring. The PRISMA review of the literature revealed that
Nordic countries focus on four major WBS objectives of ARB: assessing ARB in the human population, identifying ARB evading wastewater treatment, quantifying removal rates, and evaluating potential ARB evolution during the treatment process. In both clinical and wastewater contexts, the most studied targets were pathogens producing carbapenemase and extended-spectrum beta-lactamase (ESBL), primarily Escherichia coli and Klebsiella spp. However, vancomycin-resistant Enterococcus (VRE) and methicillin-resistant Staphylococcus aureus (MRSA) have received more attention in clinical epidemiology than in wastewater studies, probably due to their lower detection rates in wastewater. Clinical surveillance has mostly used culturing, antibiotic susceptibility testing, and genotyping, but WBS employed PCR-based and metagenomics alongside culture-based techniques. Imported cases resulting from international travel and hospitalization abroad appear to have frequently contributed to the rise in ARB pathogen cases in these countries. The many similarities between the
Nordic countries (e.g., knowledge exchange practices, antibiotic usage patterns, and the current ARB landscape) could facilitate collaborative efforts in developing and implementing WBS for ARB in population-level screening.