摘要

        人们越来越关注环境在抗生素耐药菌（ARB）和抗生素耐药基因（ARG）传播中的作用。在本系统综述中，我们总结了与农业设施和废水处理厂等潜在ARB和ARG来源相关的自然环境中ARG增加的证据。共有5247条引文被确认，包括确定ARG和ARB结果的研究。所有研究都经过筛选，以确定与问题和方法的相关性。本文仅对那些有ARG结果的研究（n=24）进行了总结。由于缺乏信息或未能控制混杂因素，16项研究在估计源效应时存在高（n=3）或不明确（n=13）的偏差风险。在9项研究中使用了统计方法；3项研究使用建模方法评估了多个来源的影响，但没有报告影响措施。大多数研究报告在源头下游/附近的精氨酸浓度较高，但异质性的发现阻碍了做出任何合理的结论。为了量化由于特定点源导致的环境中ARG的增加，有必要进行强调混杂的分析或设计控制以及提供效果度量估计的研究。

         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.

          https://www.cambridge.org/core/journals/animal-health-research-reviews/article/impact-of-point-sources-on-antibiotic-resistance-genes-in-the-natural-environment-a-systematic-review-of-the-evidence/9291877383591315C22B65608B373642