Send to

Choose Destination
Zoonoses Public Health. 2018 Feb;65(1):e162-e184. doi: 10.1111/zph.12426. Epub 2017 Dec 5.

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

Author information

Department of Veterinary Population Medicine, University of Minnesota, St. Paul, MN, USA.
Department of Veterinary and Biomedical Sciences, University of Minnesota, St. Paul, MN, USA.
Department of Epidemiology, University of Washington, Seattle, WA, USA.
Division of Environmental Health Sciences, School of Public Health, University of Minnesota, Minneapolis, MN, USA.
Department of Population Medicine and Centre for Public Health and Zoonoses, Ontario Veterinary College, University of Guelph, Guelph, ON, Canada.
Veterinary Medical Library, University of Minnesota, St. Paul, MN, USA.
Instituto de Medicina Preventiva Veterinaria, Facultad de Ciencias Veterinarias, Universidad Austral de Chile, Valdivia, Chile.


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.


antibiotic-resistant bacteria; effect measure; environmental dissemination; point source; systematic review

[Indexed for MEDLINE]

Supplemental Content

Full text links

Icon for Wiley
Loading ...
Support Center