Assessing the Impact of Wastewater Treatment Plants on Environmental Levels of Antibiotic Resistance

Williams-Nguyen, Jessica; Singer, Randall S.; Bueno, Irene

doi:10.1002/9781119192428.ch4

Cited by 1 publication

(1 citation statement)

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“…As noted in the results, even those studies that conducted statistical analysis did not report effect measures. Examples of effect measures include odds ratios or prevalence ratios (for ARB prevalence outcomes) and mean differences (for ARB concentration outcomes) (Williams‐Nguyen, Bueno, & Singer, ). For instance, as a simplified example, the effect of a point source on ARB prevalence in an adjacent waterway could be defined as a prevalence ratio wherein the prevalence of ARB at a site 100 m downstream of the point source (e.g.…”

Section: Discussionmentioning

confidence: 99%

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

Bueno

Williams-Nguyen

Hwang

et al. 2017

Zoonoses and Public Health

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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

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Section: Discussionmentioning

confidence: 99%