摘要

       废水处理厂和农业设施等点源可能在传播抗药性细菌（ARB）和抗药性基因（ARG）方面发挥作用。为了分析与这些ARB和ARG点源相关的自然环境中ARB增加的证据，我们进行了系统的回顾。我们评估了5247条通过数据库检索得到的记录，包括确定ARG和ARB结果的两项研究。所有研究都经过筛选过程，以评估与问题的相关性以及解决我们的审查问题的方法。对纳入审查的最后一批研究进行了偏倚风险评估。本文仅对ARB结果（n=47）的研究进行总结。由于缺乏信息和/或未能控制混杂因素，35项研究在估计源效应时存在高（n=11）或不明确（n=24）的偏差风险。在10项研究中使用了统计分析，其中一项研究使用建模方法评估了多个来源的影响；没有报告影响措施。大多数研究报告ARB在源头下游/附近的患病率或浓度较高。然而，这一证据主要是描述性的，不能断定点源对环境中ARB的增加有明显的影响。为了量化特定点源导致的环境中ARB的增加，有必要对压力研究设计、偏差控制和分析工具进行研究，以提供效果测量估计。

        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.

         https://onlinelibrary.wiley.com/doi/abs/10.1111/zph.12426