Existing evidence on antibiotic resistance exposure and transmission to humans from the environment: a systematic map View Full Text


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Article Info

DATE

2022-03-12

AUTHORS

Isobel Catherine Stanton, Alison Bethel, Anne Frances Clare Leonard, William Hugo Gaze, Ruth Garside

ABSTRACT

BackgroundAntimicrobial resistance (AMR) is predicted to become the leading cause of death by 2050 with antibiotic resistance being an important component. Anthropogenic pollution introduces antibiotic resistant bacteria (ARB) and antibiotic resistance genes (ARGs) to the natural environment. Currently, there is limited empirical evidence demonstrating whether humans are exposed to environmental AMR and whether this exposure can result in measurable human health outcomes. In recent years there has been increasing interest in the role of the environment and disparate evidence on transmission of AMR to humans has been generated but there has been no systematic attempt to summarise this. We aim to create two systematic maps that will collate the evidence for (1) the transmission of antibiotic resistance from the natural environment to humans on a global scale and (2) the state of antibiotic resistance in the environment in the United Kingdom.MethodsSearch strategies were developed for each map. Searches were undertaken in 13 bibliographic databases. Key websites were searched and experts consulted for grey literature. Search results were managed using EndNote X8. Titles and abstracts were screened, followed by the full texts. Articles were double screened at a minimum of 10% at both stages with consistency checking and discussion when disagreements arose. Data extraction occurred in Excel with bespoke forms designed. Data extracted from each selected study included: bibliographic information; study site location; exposure source; exposure route; human health outcome (Map 1); prevalence/percentage/abundance of ARB/antibiotic resistance elements (Map 2) and study design. EviAtlas was used to visualise outputs.ResultsFor Map 1, 40 articles were included, from 11,016 unique articles identified in searches, which investigated transmission of AMR from the environment to humans. Results from Map 1 showed that consumption/ingestion was the most studied transmission route. Exposure (n = 17), infection (n = 16) and colonisation (n = 11) being studied as an outcome a similar number of times, with mortality studied infrequently (n = 2). In addition, E. coli was the most highly studied bacterium (n = 16). For Map 2, we included 62 studies quantifying ARB or resistance elements in the environment in the UK, from 6874 unique articles were identified in the searches. The most highly researched species was mixed communities (n = 32). The most common methodology employed in this research question was phenotypic testing (n = 37). The most commonly reported outcome was the characterisation of ARBs (n = 40), followed by characterisation of ARGs (n = 35). Other genetic elements, such as screening for intI1 (n = 15) (which encodes a Class 1 integron which is used as a proxy for environmental ARGs) and point mutations (n = 1) were less frequently reported. Both maps showed that research was focused towards aquatic environments.ConclusionsBoth maps can be used by policy makers to show the global (Map 1) and UK (Map 2) research landscapes and provide an overview of the state of AMR in the environment and human health impacts of interacting with the environment. We have also identified (1) clusters of research which may be used to perform meta-analyses and (2) gaps in the evidence base where future primary research should focus. More... »

PAGES

8

References to SciGraph publications

  • 2014-08-29. Antibiotic resistance and prevalence of class 1 and 2 integrons in Escherichia coli isolated from two wastewater treatment plants, and their receiving waters (Gulf of Gdansk, Baltic Sea, Poland) in ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH
  • 2016-06-22. The induction and identification of novel Colistin resistance mutations in Acinetobacter baumannii and their implications in SCIENTIFIC REPORTS
  • 2020-06-03. What is the research evidence for antibiotic resistance exposure and transmission to humans from the environment? A systematic map protocol in ENVIRONMENTAL EVIDENCE
  • 2015-02-13. Validated predictive modelling of the environmental resistome in THE ISME JOURNAL: MULTIDISCIPLINARY JOURNAL OF MICROBIAL ECOLOGY
  • 2019-06-04. EviAtlas: a tool for visualising evidence synthesis databases in ENVIRONMENTAL EVIDENCE
  • 2018-06-22. Why do many pheasants released in the UK die, and how can we best reduce their natural mortality? in EUROPEAN JOURNAL OF WILDLIFE RESEARCH
  • 2009-03-01. Antibiotic resistance genes in water environment in APPLIED MICROBIOLOGY AND BIOTECHNOLOGY
  • 2014-12-12. Using the class 1 integron-integrase gene as a proxy for anthropogenic pollution in THE ISME JOURNAL: MULTIDISCIPLINARY JOURNAL OF MICROBIAL ECOLOGY
  • 2015-09-30. Applying the Bradford Hill criteria in the 21st century: how data integration has changed causal inference in molecular epidemiology in EMERGING THEMES IN EPIDEMIOLOGY
  • 2014-01-09. A systematic review and meta-analysis of the effects of antibiotic consumption on antibiotic resistance in BMC INFECTIOUS DISEASES
  • 2020-02-17. How effective are strategies to control the dissemination of antibiotic resistance in the environment? A systematic review in ENVIRONMENTAL EVIDENCE
  • 2011-03-03. Impacts of anthropogenic activity on the ecology of class 1 integrons and integron-associated genes in the environment in THE ISME JOURNAL: MULTIDISCIPLINARY JOURNAL OF MICROBIAL ECOLOGY
  • 2020-09-03. Evolution of antibiotic resistance at low antibiotic concentrations including selection below the minimal selective concentration in COMMUNICATIONS BIOLOGY
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    http://scigraph.springernature.com/pub.10.1186/s13750-022-00262-2

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    http://dx.doi.org/10.1186/s13750-022-00262-2

    DIMENSIONS

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    PUBMED

    https://www.ncbi.nlm.nih.gov/pubmed/35308196


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    19 schema:description BackgroundAntimicrobial resistance (AMR) is predicted to become the leading cause of death by 2050 with antibiotic resistance being an important component. Anthropogenic pollution introduces antibiotic resistant bacteria (ARB) and antibiotic resistance genes (ARGs) to the natural environment. Currently, there is limited empirical evidence demonstrating whether humans are exposed to environmental AMR and whether this exposure can result in measurable human health outcomes. In recent years there has been increasing interest in the role of the environment and disparate evidence on transmission of AMR to humans has been generated but there has been no systematic attempt to summarise this. We aim to create two systematic maps that will collate the evidence for (1) the transmission of antibiotic resistance from the natural environment to humans on a global scale and (2) the state of antibiotic resistance in the environment in the United Kingdom.MethodsSearch strategies were developed for each map. Searches were undertaken in 13 bibliographic databases. Key websites were searched and experts consulted for grey literature. Search results were managed using EndNote X8. Titles and abstracts were screened, followed by the full texts. Articles were double screened at a minimum of 10% at both stages with consistency checking and discussion when disagreements arose. Data extraction occurred in Excel with bespoke forms designed. Data extracted from each selected study included: bibliographic information; study site location; exposure source; exposure route; human health outcome (Map 1); prevalence/percentage/abundance of ARB/antibiotic resistance elements (Map 2) and study design. EviAtlas was used to visualise outputs.ResultsFor Map 1, 40 articles were included, from 11,016 unique articles identified in searches, which investigated transmission of AMR from the environment to humans. Results from Map 1 showed that consumption/ingestion was the most studied transmission route. Exposure (n = 17), infection (n = 16) and colonisation (n = 11) being studied as an outcome a similar number of times, with mortality studied infrequently (n = 2). In addition, E. coli was the most highly studied bacterium (n = 16). For Map 2, we included 62 studies quantifying ARB or resistance elements in the environment in the UK, from 6874 unique articles were identified in the searches. The most highly researched species was mixed communities (n = 32). The most common methodology employed in this research question was phenotypic testing (n = 37). The most commonly reported outcome was the characterisation of ARBs (n = 40), followed by characterisation of ARGs (n = 35). Other genetic elements, such as screening for intI1 (n = 15) (which encodes a Class 1 integron which is used as a proxy for environmental ARGs) and point mutations (n = 1) were less frequently reported. Both maps showed that research was focused towards aquatic environments.ConclusionsBoth maps can be used by policy makers to show the global (Map 1) and UK (Map 2) research landscapes and provide an overview of the state of AMR in the environment and human health impacts of interacting with the environment. We have also identified (1) clusters of research which may be used to perform meta-analyses and (2) gaps in the evidence base where future primary research should focus.
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    25 schema:keywords AMR
    26 Abstract
    27 BackgroundAntimicrobial resistance
    28 E. coli
    29 EndNote X8
    30 Excel
    31 Kingdom
    32 MAP-1
    33 MAP-2
    34 MethodsSearch strategies
    35 UK
    36 United Kingdom
    37 X8
    38 abundance
    39 addition
    40 anthropogenic pollution
    41 antibiotic resistance
    42 antibiotic resistance elements
    43 antibiotic resistance genes
    44 antibiotic-resistant bacteria
    45 aquatic environment
    46 article
    47 attempt
    48 bacteria
    49 bacterium
    50 base
    51 bespoke form
    52 bibliographic databases
    53 bibliographic information
    54 cause
    55 cause of death
    56 characterisation
    57 checking
    58 clusters
    59 clusters of research
    60 coli
    61 colonisation
    62 common methodology
    63 community
    64 components
    65 consistency checking
    66 data
    67 data extraction
    68 database
    69 death
    70 design
    71 disagreement
    72 discussion
    73 disparate evidence
    74 elements
    75 empirical evidence
    76 environment
    77 evidence
    78 evidence base
    79 experts
    80 exposure
    81 exposure routes
    82 exposure sources
    83 extraction
    84 form
    85 full text
    86 future primary research
    87 gap
    88 genes
    89 genetic elements
    90 global scale
    91 grey literature
    92 health impacts
    93 health outcomes
    94 human health impacts
    95 human health outcomes
    96 humans
    97 impact
    98 important component
    99 infection
    100 information
    101 ingestion
    102 intI1
    103 interest
    104 key websites
    105 landscape
    106 literature
    107 location
    108 makers
    109 maps
    110 methodology
    111 minimum
    112 mortality
    113 mutations
    114 natural environment
    115 number
    116 outcomes
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    119 phenotypic testing
    120 point mutations
    121 policy makers
    122 pollution
    123 primary research
    124 questions
    125 recent years
    126 research
    127 research landscape
    128 research questions
    129 resistance
    130 resistance elements
    131 resistance genes
    132 resistant bacteria
    133 results
    134 role
    135 route
    136 scale
    137 search
    138 search results
    139 similar number
    140 site location
    141 source
    142 species
    143 stage
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    145 strategies
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    149 systematic attempt
    150 systematic map
    151 testing
    152 text
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    157 transmission routes
    158 unique articles
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