Impacts of Antibiotic Residues in the Environment on Bacterial Resistance and Human Health in Eastern China: An Interdisciplinary Mixed-Methods Study Protocol

Abstract

Antibiotic resistance is a global health challenge that threatens human and animal lives, especially among low-income and vulnerable populations in less-developed countries. Its multi-factorial nature requires integrated studies on antibiotics and resistant bacteria in humans, animals, and the environment. To achieve a comprehensive understanding of the situation and management of antibiotic use and environmental transmission, this paper describes a study protocol to document human exposure to antibiotics from major direct and indirect sources, and its potential health outcomes. Our mixed-methods approach addresses both microbiological and pathogen genomics, and epidemiological, geospatial, anthropological, and sociological aspects. Implemented in two rural residential areas in two provinces in Eastern China, linked sub-studies assess antibiotic exposure in population cohorts through household surveys, medicine diaries, and biological sampling; identify the types and frequencies of antibiotic resistance genes in humans and food-stock animals; quantify the presence of antibiotic residues and antibiotic resistance genes in the aquatic environment, including wastewater; investigate the drivers and behaviours associated with human and livestock antibiotic use; and analyse the national and local policy context, to propose strategies and systematic measurements for optimising and monitoring antibiotic use. As a multidisciplinary collaboration between institutions in the UK and China, this study will provide an in-depth understanding of the influencing factors and allow comprehensive awareness of the complexity of AMR and antibiotic use in rural Eastern China.

Why and How Epidemiologists Should Use Mixed Methods

“… 35 There are fewer examples of epidemiologic studies that also integrate results during the analysis phase. 36 , 37 We now describe a case study that exemplifies mixed-methods integration in observational epidemiology.…”

Impact of the COVID-19 Outbreak on the Antibiotic Use Patterns among a Rural Community Population in Eastern China

“…Study design: This study was from research carried out in a rural community in Eastern China in June 2019, as presented in our previous paper [ 66 ]. Data collected from August to December 2019 was the “prior” period of the COVID-19 outbreak in China, and those during the same five months in 2020 were the “post” period, during which no local cases of COVID-19 infection were reported in Deqing County.…”

“…Two surveys in June 2019 and July 2020 using the same questionnaire through a face-to-face interview were carried out to collect information on the demographic variables (sex, age, ethnicity, education level, marriage status, occupation, and annual household income) and the history of chronic diseases in the same site. The details of the questionnaire were described in our study protocol paper [ 66 ]. The education level was the highest grade completed by the participant and was described as ≤6 years (elementary school and below) and >6 years (junior school and above).…”

“…To describe the patterns of antibiotic use in the population, a structured self-administered diary was used to collect the medicine use (antibiotics and chronic disease medicine) and individual health status in each participating household over a 12-month period, as described in our study protocol paper [ 66 ]. The data on the medicines used for each household member were recorded weekly by participants using the structured form to capture the types, reasons, sources, frequencies, doses, side effects, and other details of both antibiotic use and the use of other medicines for long-term conditions.…”

Development of Novel Peptide-Modified Silver Nanoparticle-Based Rapid Biosensors for Detecting Aminoglycoside Antibiotics

“…However, the extensive and frequently improper use of AGAs has given rise to concerns regarding their adverse impact on human health, environmental pollution, and the emergence of antimicrobial resistance (AMR) . The ubiquitous use of AGAs in agriculture and veterinary medicine has resulted in their presence in surface runoff, water bodies, and environmental samples, leading to potential ecological consequences. , In addition to serious public health threats and risk of spreading resistance is evident across different geographical regions, ecological systems, and species . In the clinical setting, careful dosing and regular monitoring of AGA blood levels are essential due to their potential adverse effects, including nephrotoxicity, cytotoxicity, and ototoxicity. , Moreover, the adulteration of animal-derived meat and dairy products with AGAs has raised concerns about their impact as endocrine disruptors in humans. , To address these concerns, health organizations worldwide have implemented strict regulations to monitor and control AGA residue levels in plant- and animal-derived food products, as well as in environmental samples and consumer goods. − The need for highly sensitive analytical methods to detect and quantify trace levels of AG residues in real-world samples is critical to ensure compliance with these regulations and maximum residue limits (MRLs). , Therefore, there is an urgent demand for developing novel, cost-effective, and rapid screening methods for the detection of AGAs, which can be easily implemented in diverse settings, including laboratories, industries, and inspection facilities.…”