Do wastewater treatment plants increase antibiotic resistant bacteria or genes in the environment? Protocol for a systematic review
- Published
- Accepted
- Subject Areas
- Microbiology, Epidemiology, Environmental Impacts
- Keywords
- antibiotic resistance bacteria, wastewater treatment plants, environmental samples, antibiotic resistance genes, systematic review protocol
- Copyright
- © 2019 Rodríguez-Molina et al.
- Licence
- This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, reproduction and adaptation in any medium and for any purpose provided that it is properly attributed. For attribution, the original author(s), title, publication source (PeerJ Preprints) and either DOI or URL of the article must be cited.
- Cite this article
- 2019. Do wastewater treatment plants increase antibiotic resistant bacteria or genes in the environment? Protocol for a systematic review. PeerJ Preprints 7:e27727v1 https://doi.org/10.7287/peerj.preprints.27727v1
Abstract
Background. Antibiotic resistance is a global public health threat. Water from human activities is collected at wastewater treatment plants where processes often do not sufficiently neutralize antibiotic resistant bacteria and genes, which are further shed into the local environment. This protocol outlines the steps to conduct a systematic review based on the Population, Exposure, Comparator and Outcome (PECO) framework, aiming at answering the question Are antimicrobial-resistant enterobacteriaceae and antimicrobial resistance genes present (O) in air and water samples (P) taken either near or downstream or downwind or down-gradient from wastewater treatment plants (E), as compared to air and water samples taken either further away or upstream or upwind or up-gradient from such wastewater treatment plant (C)? Presence of antimicrobial-resistant bacteria and genes will be quantitatively measured by extracting their prevalence or concentration, depending on the reviewed study.
Methods. We will search PubMed, EMBASE, the Cochrane database and Web of Science for original articles published from 01-Jan-2000 to 03-Sep-2018 with language restriction. Articles will undergo a relevance and a design screening process. Data from eligible articles will be extracted by two independent reviewers. Further, we will perform a risk of bias assessment using a decision matrix. We will synthesize and present results in narrative and tabular form and will perform a meta-analysis if heterogeneity of results allows it.
Discussion. Antibiotic resistance in environmental samples around wastewater treatment plants may pose a risk of exposure to workers and nearby residents. Results from the systematic review outlined in this protocol will allow to estimate the extend of exposure, to inform policy making and help to design future studies.
Author Comment
This is a preprint submission to PeerJ Preprints. This version of the systematic review protocol was submitted to PROSPERO for registration but was not accepted because it is a review of in vitro studies. PROSPERO's reply is included as part of the supplementary material. This version is yet to be submitted for publication in a peer-reviewed journal.