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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.
|Original language||English (US)|
|Journal||Zoonoses and Public Health|
|State||Published - Feb 1 2018|
Bibliographical noteFunding Information:
We thank Dr. Annette O’Connor (Iowa State University) for her helpful insight during the protocol development process. Partial funding for this project was provided by the National Pork Board, United States (NPB Project #13-260). This funding source was not involved in any aspect of the review design, inclusion/exclusion decisions, data collection or formulation of conclusions.
- antibiotic-resistant bacteria
- effect measure
- environmental dissemination
- point source
- systematic review
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Systematic Review and Evidence Synthesis Service
Kocher, M. M., Riegelman, A. L. & Theis-Mahon, N.
1/1/18 → …
Project: Other project