Wastewater Surveillance of Antimicrobial Resistance in Human Populations: A Systematic Review
Wastewater Surveillance of Antimicrobial Resistance in Human Populations: A Systematic Review
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DOI：
10.20944/preprints202010.0267.v1
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发表时间：
2020-10
期刊：
影响因子：
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通讯作者：
K. Chau;L. Barker;N. Sims;B. Kasprzyk-Hordern;E. Budgell;E. Harriss;D. Crook;D. Read;S. Walker;N. Stoesser
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作者：
K. Chau;L. Barker;N. Sims;B. Kasprzyk-Hordern;E. Budgell;E. Harriss;D. Crook;D. Read;S. Walker;N. Stoesser
基于水的抗菌素耐药性（AMR）监测可能有助于方便地监测人群水平的AMR患病率，而没有医疗保健相关的偏倚和临床导向系统固有的数据收集限制。然而，研究设计和方法的差异可能导致结果和解释的差异，限制了重复性，可靠性和荟萃分析。因此，我们系统地回顾了使用废水进行人群AMR监测的研究，以确定检测废水-人体AMR相关性的最佳实践。我们在两阶段筛选中评估了7，063条记录和174种全文方法;纳入了20项研究。偏倚风险评估将研究分为高风险（n=3）、低风险（n=3）和不明确风险（n=14）。大多数研究检测到了废水-人体AMR相关性（n=15），但只有6项研究确定了统计学显著性相关性，大多数是通过非培养方法（n=5）。基因组学方法也促进了更高分辨率的AMR监测，而基于培养的研究主要对特定微生物和表型AMR谱进行观察比较。确定废水-人体AMR相关性的研究始终与废水进水采样相关，而与其他方法无关。对于纵向研究，>=6个月的时间范围也类似。大多数确定废水-人体AMR相关性的进水研究使用复合（n=5）或流量比例废水采样方法（n=4）;然而，总体而言，抓取采样是最常见的（n=6），并且通常看起来类似有效。我们的审查支持使用复合采样（至少）作为标准的废水进水采样。其他方法的影响不太清楚;然而，纵向研究的最短时间框架为6个月，并增加独立于文化的研究的采样覆盖率，以进行充分的生物统计分析似乎是明智的。随着这一相对较新的领域的发展，需要更多具有明确的基于废水的人群水平AMR监测目标的研究，以更好地确定混杂特征的影响，并验证全面的“最佳实践”方案。
Wastewater-based surveillance of antimicrobial resistance (AMR) may facilitate convenient monitoring of population-level AMR prevalence without the healthcare-associated bias and data collection restrictions inherent to clinically oriented systems. However, differences in study design and methodology likely contribute to differences in outcomes and interpretation, limiting reproducibility, reliability and meta-analysis. We therefore systematically reviewed studies using wastewater for AMR surveillance in human populations to identify optimal practices to detect wastewater-human AMR correlations. We evaluated 7,063 records and 174 full-text methods in a two-stage screen; 20 studies were included. Risk of bias assessment divided studies into high-risk (n=3), low-risk (n=3) and unclear-risk (n=14). Most studies detected wastewater-human AMR correlations (n=15) but only six studies identified statistically significant associations, most via culture-independent approaches (n=5). Genomic approaches also facilitated higher-resolution AMR monitoring whereas culture-based studies primarily undertook observational comparisons of specific organisms and phenotypic AMR profiles. Studies identifying wastewater-human AMR correlations were consistently associated with sampling wastewater influent irrespective of other methodological approaches. For longitudinal studies, a timeframe of >=6 months was similarly associated. Most influent studies identifying wastewater-human AMR correlations used composite (n=5) or flow-proportional wastewater sampling methods (n=4); however, grab sampling was commonest overall (n=6) and generally appeared similarly effective.Wastewater-based surveillance of AMR in human populations appears relatively robust, with most included studies reporting a correlation despite high diversity in study design and methodology. Our review supports sampling of wastewater influent using composite sampling (at a minimum) as a standard. Impacts of other methodological approaches are less clear; however, a minimum timeframe of six months for longitudinal studies, and increased sampling coverage for culture-independent studies to enable adequate biostatistical analyses appear sensible. As this relatively new field grows, more studies with clear wastewater-based population-level AMR surveillance aims are needed to better determine the impact of confounding features and validate comprehensive “best practice” protocols.