title: What is the evidence that point sources of anthropogenic effluent increase antibiotic resistance in the environment? Protocol for a systematic review.
abstract: Herein we describe a protocol for a systematic review of the evidence on whether point sources of anthropogenic effluent are associated with an increase in antibiotic resistance in the adjacent environment. The review question was based on the Population, Exposure, Comparator, Outcome, Study Design (PECOS) framework as follows: Is the prevalence or concentration of antibiotic resistant bacteria or resistance genes (O) in soil, water, air or free-living wildlife (P) higher in close proximity to, or downstream from, known or suspected sources of anthropogenic effluent (E) compared to areas more distant from or upstream from these sources (C)? A comprehensive search strategy was created to capture all relevant, published literature. Criteria for two stages of eligibility screening were developed to exclude publications that were not relevant to the question, and determine if the study used a design that permitted estimation of an association between a source and levels of resistance. A decision matrix was created for assessment of risk of bias to internal validity due to sample selection bias, information bias, and confounding. The goal of this protocol is to provide a method for determining the state of knowledge about the effect of point sources on antibiotic resistance in the environment.
authors.affiliation: Department of Epidemiology,University of Washington,1959 NE Pacific Street,Health Sciences Building F-262,Box 357236,Seattle,WA 98195,USA.
authors.forename: Jessica
authors.identifier: 0000-0003-0643-7433
authors.initials: J
authors.lastname: Williams-Nguyen
authors.affiliation: Department of Veterinary Population Medicine,University of Minnesota,1988 Fitch Avenue,St. Paul,MN 55108,USA.
authors.forename: Irene
authors.initials: I
authors.lastname: Bueno
authors.affiliation: 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.
authors.forename: Jan M
authors.initials: JM
authors.lastname: Sargeant
authors.affiliation: Veterinary Medical Library,University of Minnesota,1971 Commonwealth Avenue,St. Paul,MN 55108,USA.
authors.forename: André J
authors.initials: AJ
authors.lastname: Nault
authors.affiliation: Department of Veterinary and Biomedical Sciences,University of Minnesota,1971 Commonwealth Avenue,St. Paul,MN 55108,USA.
authors.forename: Randall S
authors.identifier: 0000-0002-5461-9330
authors.initials: RS
authors.lastname: Singer
mesh_terms: D000818:Animals; D015982:Bias; D002985:Clinical Protocols; D015986:Confounding Factors, Epidemiologic; D003430:Cross-Sectional Studies; D004352:Drug Resistance, Microbial / Q000235:genetics; D004787:Environmental Pollution / Q000009:adverse effects*; D006802:Human Activities; D006801:Humans; D064887:Observational Studies as Topic / Q000592:standards; D015203:Reproducibility of Results; D012307:Risk Factors; D015983:Selection Bias; D000078202:Systematic Reviews as Topic
keywords: antibiotic resistance; environment; point source; systematic review protocol