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Anim Health Res Rev. 2017 Dec;18(2):112-127. doi: 10.1017/S146625231700007X. Epub 2017 Dec 12.

Impact of point sources on antibiotic resistance genes in the natural environment: a systematic review of the evidence.

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Department of Veterinary Population Medicine,University of Minnesota,1988 Fitch Avenue,St. Paul,MN 55108,USA.
Department of Veterinary and Biomedical Sciences,University of Minnesota,1971 Commonwealth Avenue,St. Paul,MN 55108,USA.
Division of Environmental Health Sciences,School of Public Health,University of Minnesota,420 Delaware St. SE,Minneapolis,MN 55455,USA.
Department of Population Medicine and Centre for Public Health and Zoonoses,Ontario Veterinary College,University of Guelph,50 Stone Road East,Guelph,Ontario N1G 2W1,Canada.
Veterinary Medical Library,University of Minnesota,1971 Commonwealth Avenue,St. Paul,MN 55108,USA.


There is a growing concern about the role of the environment in the dissemination of antibiotic resistant bacteria (ARB) and antibiotic resistance genes (ARG). In this systematic review, we summarize evidence for increases of ARG in the natural environment associated with potential sources of ARB and ARG such as agricultural facilities and wastewater treatment plants. A total of 5247 citations were identified, including studies that ascertained both ARG and ARB outcomes. All studies were screened for relevance to the question and methodology. This paper summarizes the evidence only for those studies with ARG outcomes (n = 24). Sixteen studies were at high (n = 3) or at unclear (n = 13) risk of bias in the estimation of source effects due to lack of information or failure to control for confounders. Statistical methods were used in nine studies; three studies assessed the effect of multiple sources using modeling approaches, and none reported effect measures. Most studies reported higher ARG concentration downstream/near the source, but heterogeneous findings hindered making any sound conclusions. To quantify increases of ARG in the environment due to specific point sources, there is a need for studies that emphasize analytic or design control of confounding, and that provide effect measure estimates.


antibiotic resistance genes; effect measure; point source; systematic review

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