What is the research evidence for antibiotic resistance exposure and transmission to humans from the environment? A systematic map protocol

Abstract

Background: Antimicrobial resistance (AMR) is a public health crisis that is predicted to cause 10 million deaths per year by 2050. The environment has been implicated as a reservoir of AMR and is suggested to play a role in the dissemination of antibiotic resistance genes (ARGs). Currently, most research has focused on measuring concentrations of antibiotics and characterising the abundance and diversity of ARGs and antibiotic resistant bacteria (ARB) in the environment. To date, there has been limited empirical research on whether humans are exposed to this, and whether exposure can lead to measureable impacts on human health. Therefore, the objective of this work is to produce two linked systematic maps to investigate previous research on exposure and transmission of AMR to humans from the environment. The first map will investigate the available research relating to exposure and transmission of ARB/ARGs from the environment to humans on a global scale and the second will investigate the prevalence of ARB/ARGs in various environments in the UK. These two maps will be useful for policy makers and research funders to identify where there are significant gluts and gaps in the current research, and where more primary and synthesis research needs to be undertaken. Methods: Separate search strategies will be developed for the two maps. Searches will be run in 13 databases, and grey literature will be sought from key websites and engagement with experts. Hits will be managed in EndNote and screened in two stages (title/abstract then full text) against predefined inclusion criteria. A minimum of 10% will be double screened with ongoing consistency checking. All included studies will have data extracted into a bespoke form designed and piloted for each map. Data to be extracted will include bibliographic details, study design, location, exposure source, exposure route, health outcome (Map 1); and prevalence/percentage of ARB/ARG (Map 2). No validity appraisal will be undertaken. Results will be tabulated and presented narratively, together with graphics showing the types and areas of research that has been undertaken and heatmaps for key exposure-health outcomes (Map 1) and exposure-prevalence (Map 2).

One Health or Three? Transmission modelling ofKlebsiellaisolates reveals ecological barriers to transmission between humans, animals and the environment

“…The sequencing of large and carefully sampled collections of isolates holds the promise to inform an overarching model describing the rate of transmission between settings 23 , and to simultaneously shed light on the relevant biological and ecological factors underpinning transmission barriers. Whilst commonalities of gene and community profiles between settings point to ample opportunities for mixing, the risks to public health of environmental reservoirs of AMR remain difficult to gauge in the absence of this broad framework 10,24,25 . Recent advances in bioinformatics tools and analytical approaches provide the means to extract critical added value from genome data, and thus to provide a more nuanced view of how microbes and mobile elements move through complex ecosystems.…”

Genomic Insights of Multidrug-Resistant Escherichia coli From Wastewater Sources and Their Association With Clinical Pathogens in South Africa

“…The role of the environment in the spread of antibiotic resistance is an evolving issue (1). Wastewater treatment plants (WWTPs) have received a lot of attention because of the central role they play in reducing pollutant loads that include antibiotic-resistant bacteria (ARB), antibiotic resistance genes (ARGs), virulence genes, and their associated mobile genetic elements to acceptable limits before the discharge of treated effluent into receiving water bodies.…”

Country Income Is Only One of the Tiles: The Global Journey of Antimicrobial Resistance among Humans, Animals, and Environment

“…The occurrence of MDR bacteria in wildlife is clearly influenced by many and different factors that have not yet been fully understood [ 99 , 100 ]. Most research has focused on measuring concentrations of antibiotics and characterizing the abundance and diversity of ARGs and MDR bacteria in the environment, but there has been limited empirical research on whether humans are exposed to this, and whether exposure can lead to measurable impacts on human health [ 101 ].…”