Systematic Review: Impact of point sources on antibiotic‐resistant bacteria in the natural environment

Abstract

SummaryPoint sources such as wastewater treatment plants and agricultural facilities may have a role in the dissemination of antibiotic-resistant bacteria (ARB) and antibiotic resistance genes (ARG). To analyse the evidence for increases in ARB in the natural environment associated with these point sources of ARB and ARG, we conducted a systematic review. We evaluated 5,247 records retrieved through database searches, including both studies that ascertained ARG and ARB outcomes. All studies were subjected to a screening process to assess relevance to the question and methodology to address our review question. A risk of bias assessment was conducted upon the final pool of studies included in the review. This article summarizes the evidence only for those studies with ARB outcomes (n = 47). Thirty-five studies were at high (n = 11) or at unclear (n = 24) risk of bias in the estimation of source effects due to lack of information and/ or failure to control for confounders. Statistical analysis was used in ten studies, of which one assessed the effect of multiple sources using modelling approaches; none reported effect measures. Most studies reported higher ARB prevalence or concentration downstream/near the source. However, this evidence was primarily descriptive and it could not be concluded that there is a clear impact of point sources on increases in ARB in the environment. To quantify increases in ARB in the environment due to specific point sources, there is a need for studies that stress study design, control of biases and analytical tools to provide effect measure estimates. K E Y W O R D Santibiotic-resistant bacteria, effect measure, environmental dissemination, point source, systematic review

Molecular Epidemiology of Staphylococcus aureus Lineages in Wild Animals in Europe: A Review

“…Heavy metals and disinfectants with antibacterial properties also favor the bacterial resistance present in these waters [100]. Surface waters are the main recipient of treated and untreated wastewaters favoring the dissemination of resistance genes in microbial communities via water, land or even through wildlife [102]. Nonetheless, only a few studies have been carried out in Europe in order to determine the presence of S. aureus, its antimicrobial resistance profiles, and its genetic lineages in surface waters [56,[103][104][105].…”

Complexities in understanding antimicrobial resistance across domesticated animal, human, and environmental systems

“…This argues for greater unification among methods and study designs to provide less ambiguous results. A recent review concluded that there was a broad lack of quantitative causal research that associates AMR sources and increases in environmental ARB, suggesting that improved study design, greater consideration of a priori bias, and standardization of analytical tools are important to understanding better how ARBs in the environment affect human and animal health …”

How effective are strategies to control the dissemination of antibiotic resistance in the environment? A systematic review

“…A third objective of this systematic review was to provide an overview of available evidence on what happens in the environment when it is exposed to different sources of ATBR. A systematic review has been published during the course of our work on impacts of point sources on ARB in natural environment [21]. Considering that similar articles were retrieved by our searches, we chose to include them in the evidence map.…”