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Systematic Review: Impact of point sources on antibiotic‐resistant bacteria in the natural environment
Author(s) -
Bueno I.,
WilliamsNguyen J.,
Hwang H.,
Sargeant J. M.,
Nault A. J.,
Singer R. S.
Publication year - 2018
Publication title -
zoonoses and public health
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.87
H-Index - 65
eISSN - 1863-2378
pISSN - 1863-1959
DOI - 10.1111/zph.12426
Subject(s) - confounding , environmental health , medicine , relevance (law) , clinical study design , antibiotic resistance , statistics , antibiotics , microbiology and biotechnology , risk analysis (engineering) , biology , mathematics , clinical trial , political science , law
Summary Point 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.