2013
DOI: 10.1289/ehp.1206316
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Human Health Risk Assessment (HHRA) for Environmental Development and Transfer of Antibiotic Resistance

Abstract: Background: Only recently has the environment been clearly implicated in the risk of antibiotic resistance to clinical outcome, but to date there have been few documented approaches to formally assess these risks.Objective: We examined possible approaches and sought to identify research needs to enable human health risk assessments (HHRA) that focus on the role of the environment in the failure of antibiotic treatment caused by antibiotic-resistant pathogens.Methods: The authors participated in a workshop held… Show more

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Cited by 577 publications
(351 citation statements)
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References 89 publications
(103 reference statements)
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“…As a route of transmission the extent of human exposure to antibiotic resistant bacteria from the natural environment is not fully understood and is likely to be an underestimated phenomenon (Ashbolt et al, 2013;Finley et al, 2013;Heuer et al, 2011;Wellington et al, 2013). Anthropogenic activities that lead to the introduction of human / animal associated bacteria or antibiotics into the environment may, for example, allow for the exchange and selection of resistance genes between the environmental resistome and clinically important pathogens.…”
Section: Introductionmentioning
confidence: 99%
“…As a route of transmission the extent of human exposure to antibiotic resistant bacteria from the natural environment is not fully understood and is likely to be an underestimated phenomenon (Ashbolt et al, 2013;Finley et al, 2013;Heuer et al, 2011;Wellington et al, 2013). Anthropogenic activities that lead to the introduction of human / animal associated bacteria or antibiotics into the environment may, for example, allow for the exchange and selection of resistance genes between the environmental resistome and clinically important pathogens.…”
Section: Introductionmentioning
confidence: 99%
“…As a serious concern, the environmental reservoirs are a source of emergence and transfer of ARGs from environmental to introduced bacteria into those pathogenic to humans and animals [26,27]. Consequently, the environmental contamination by antibiotic resistance is potentially associated with impacts on human and animal health.…”
mentioning
confidence: 99%
“…However, there are biologically plausible indications that contaminated raw water, wastewater and other environmental determinants may be playing an important role in the development and spread of AMR. It is unclear, the extent to which countries are conducting risk assessments to identify risks and management goals, which can guide the development of environmental management options, with clear indicators of effectiveness [29]. The assessment of the environmental risks is however not straight forward, as naturally occurring resistance genes can be present in the environment [12,29].…”
Section: Antimicrobial Resistance and The Water Sanitation And Hygiementioning
confidence: 99%
“…The application of animal waste (biosolids) to agricultural soils (as soil conditioner) is commonly practised in the United States, Europe and Australia [47], and this acts as an entry point of both antibiotics and genetic resistance determinants into the environment [7,29,48]. Enteric bacteria can remain persistent in the environment for weeks to months, depending on species and temperature.…”
Section: Soil-borne Resistancementioning
confidence: 99%
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