Ashbolt, Nicholas J.20; Amézquita, Alejandro3; Backhaus, Thomas4; Borriello, Peter5; Brandt, Kristian Koefoed21; Collignon, Peter6; Coors, Anja7; Finley, Rita22; Gaze, William H.9; Heberer, Thomas10; Lawrence, John R.11; Larsson, D.G. Joakim23; McEwen, Scott A.24; Ryan, James J.14; Schönfeld, Jens15; Silley, Peter16; Snape, Jason R.17; Van den Eede, Christel18; Topp, Edward19
1 Microbial Ecology and Biotechnology, Department of Plant and Environmental Sciences, Faculty of Science, Københavns Universitet2 U.S. Environmental Protection Agency3 Unilever-Safety and Environmental Assurance Centre4 Gothenburg University5 Veterinary medicines directorate6 Australian National University7 ECT Oekotoxikologie GmbH8 Public Health Agency of Canada9 Exeter University Medical School10 Federal Office of Consumer Protection and Food Safety11 Environment Canada12 University of Gothenburg13 University of Guelph14 GlaxoSmithKline Pharmaceuticals plc15 Umweltbundesamt Federal Environment Agency16 MB Consult Limited17 AstraZeneca18 Pfizer Animal Health VMRD19 Agriculture & Agri-Food Canada20 U.S. Environmental Protection Agency21 Microbial Ecology and Biotechnology, Department of Plant and Environmental Sciences, Faculty of Science, Københavns Universitet22 Public Health Agency of Canada23 University of Gothenburg24 University of Guelph
Background: Only recently has the environment been clearly implicated in the risk of antibiotic resistance to clinical outcome, but to date there have been few documented approaches to formally assess these risks. Objective: We examined possible approaches and sought to identify research needs to enable human health risk assessments (HHRA) that focus on the role of the environment in the failure of antibiotic treatment caused by antibiotic-resistant pathogens. Methods: The authors participated in a workshop held 4-8 March 2012 in Québec, Canada, to define the scope and objectives of an environmental assessment of antibiotic-resistance risks to human health. We focused on key elements of environmental-resistance-development "hot spots," exposure assessment (unrelated to food), and dose response to characterize risks that may improve antibiotic-resistance management options. Discussion: Various novel aspects to traditional risk assessments were identified to enable an assessment of environmental antibiotic resistance. These include a) accounting for an added selective pressure on the environmental resistome that, over time, allows for development of antibiotic-resistant bacteria (ARB); b) identifying and describing rates of horizontal gene transfer (HGT) in the relevant environmental "hot spot" compartments; and c) modifying traditional dose-response approaches to address doses of ARB for various health outcomes and pathways. Conclusions: We propose that environmental aspects of antibiotic-resistance development be included in the processes of any HHRA addressing ARB. Because of limited available data, a multi-criteria decision analysis approach would be a useful way to undertake an HHRA of environmental antibiotic resistance that informs risk managers.
Environmental Health Perspectives, 2013, Vol 121, Issue 9, p. 993-1001