Human Health Risk Assessment (HHRA) for Environmental Development and Transfer of Antibiotic Resistance

Overview

Journal Environ Health Perspect

Date 2013 Jul 11

PMID 23838256

Citations 136

Authors

Nicholas J Ashbolt

Alejandro Amezquita

Thomas Backhaus

Peter Borriello

Kristian K Brandt

Peter Collignon

Anja Coors

Rita Finley

William H Gaze

Thomas Heberer

John R Lawrence

D G Joakim Larsson

Scott A McEwen

James J Ryan

Jens Schonfeld

Peter Silley

Jason R Snape

Christel Van den Eede

Edward Topp

Affiliations

Soon will be listed here.

Abstract

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 multicriteria decision analysis approach would be a useful way to undertake an HHRA of environmental antibiotic resistance that informs risk managers.

Citing Articles

Occurrence of Antibiotic-Resistant Bacteria in Urban Surface Water Sources in Bangladesh.

Islam M, Islam M, Neela F, Hasanuzzaman A Curr Microbiol. 2025; 82(2):96.

PMID: 39833477 DOI: 10.1007/s00284-025-04082-8.

Antimicrobial resistance in fish and poultry: Public health implications for animal source food production in Nigeria, Egypt, and South Africa.

Okon E, Okocha R, Adesina B, Ehigie J, Alabi O, Bolanle A Front Antibiot. 2025; 1():1043302.

PMID: 39816413 PMC: 11732016. DOI: 10.3389/frabi.2022.1043302.

An eco-evolutionary perspective on antimicrobial resistance in the context of One Health.

Bustamante M, Mei S, Daras I, van Doorn G, Falcao Salles J, de Vos M iScience. 2025; 28(1):111534.

PMID: 39801834 PMC: 11719859. DOI: 10.1016/j.isci.2024.111534.

Synergizing Ecotoxicology and Microbiome Data Is Key for Developing Global Indicators of Environmental Antimicrobial Resistance.

Makumbi J, Leareng S, Pierneef R, Makhalanyane T Microb Ecol. 2024; 87(1):150.

PMID: 39611949 PMC: 11607014. DOI: 10.1007/s00248-024-02463-3.

Bacterial isolates from drinking water river sources exhibit multi-drug resistant trait.

Popoola B, Ogwerel J, Oladipo O Environ Monit Assess. 2024; 196(11):1054.

PMID: 39404931 PMC: 11480157. DOI: 10.1007/s10661-024-13117-9.

References

Lienert J, Koller M, Konrad J, McArdell C, Schuwirth N . Multiple-criteria decision analysis reveals high stakeholder preference to remove pharmaceuticals from hospital wastewater. Environ Sci Technol. 2011; 45(9):3848-57. DOI: 10.1021/es1031294. View

Dolejska M, Frolkova P, Florek M, Jamborova I, Purgertova M, Kutilova I . CTX-M-15-producing Escherichia coli clone B2-O25b-ST131 and Klebsiella spp. isolates in municipal wastewater treatment plant effluents. J Antimicrob Chemother. 2011; 66(12):2784-90. DOI: 10.1093/jac/dkr363. View

Coleman B, Salvadori M, McGeer A, Sibley K, Neumann N, Bondy S . The role of drinking water in the transmission of antimicrobial-resistant E. coli. Epidemiol Infect. 2011; 140(4):633-42. DOI: 10.1017/S0950268811001038. View

Shi P, Jia S, Zhang X, Zhang T, Cheng S, Li A . Metagenomic insights into chlorination effects on microbial antibiotic resistance in drinking water. Water Res. 2012; 47(1):111-20. DOI: 10.1016/j.watres.2012.09.046. View

Pires S, Hald T . Assessing the differences in public health impact of salmonella subtypes using a bayesian microbial subtyping approach for source attribution. Foodborne Pathog Dis. 2009; 7(2):143-51. DOI: 10.1089/fpd.2009.0369. View

Gaze W, Zhang L, Abdouslam N, Hawkey P, Calvo-Bado L, Royle J . Impacts of anthropogenic activity on the ecology of class 1 integrons and integron-associated genes in the environment. ISME J. 2011; 5(8):1253-61. PMC: 3146270. DOI: 10.1038/ismej.2011.15. View

Kummerer K . Antibiotics in the aquatic environment--a review--part I. Chemosphere. 2009; 75(4):417-34. DOI: 10.1016/j.chemosphere.2008.11.086. View

Ruzante J, Davidson V, Caswell J, Fazil A, Cranfield J, Henson S . A multifactorial risk prioritization framework for foodborne pathogens. Risk Anal. 2009; 30(5):724-42. DOI: 10.1111/j.1539-6924.2009.01278.x. View

Andersson D, Hughes D . Persistence of antibiotic resistance in bacterial populations. FEMS Microbiol Rev. 2011; 35(5):901-11. DOI: 10.1111/j.1574-6976.2011.00289.x. View

10.

Dotto C, Mannina G, Kleidorfer M, Vezzaro L, Henrichs M, McCarthy D . Comparison of different uncertainty techniques in urban stormwater quantity and quality modelling. Water Res. 2012; 46(8):2545-58. DOI: 10.1016/j.watres.2012.02.009. View

11.

Pontiroli A, Rizzi A, Simonet P, Daffonchio D, Vogel T, Monier J . Visual evidence of horizontal gene transfer between plants and bacteria in the phytosphere of transplastomic tobacco. Appl Environ Microbiol. 2009; 75(10):3314-22. PMC: 2681637. DOI: 10.1128/AEM.02632-08. View

12.

Gillings M, Stokes H . Are humans increasing bacterial evolvability?. Trends Ecol Evol. 2012; 27(6):346-52. DOI: 10.1016/j.tree.2012.02.006. View

13.

Motamarri S, Boccelli D . Development of a neural-based forecasting tool to classify recreational water quality using fecal indicator organisms. Water Res. 2012; 46(14):4508-20. DOI: 10.1016/j.watres.2012.05.023. View

14.

Evans M, Northey G, Sarvotham T, Rigby C, Hopkins A, Thomas D . Short-term and medium-term clinical outcomes of quinolone-resistant Campylobacter infection. Clin Infect Dis. 2009; 48(11):1500-6. DOI: 10.1086/598932. View

15.

Taylor N, Verner-Jeffreys D, Baker-Austin C . Aquatic systems: maintaining, mixing and mobilising antimicrobial resistance?. Trends Ecol Evol. 2011; 26(6):278-84. DOI: 10.1016/j.tree.2011.03.004. View

16.

Wilson M, Chen L . NDM-1 and the Role of Travel in Its Dissemination. Curr Infect Dis Rep. 2012; 14(3):213-26. DOI: 10.1007/s11908-012-0252-x. View

17.

de Kraker M, Davey P, Grundmann H . Mortality and hospital stay associated with resistant Staphylococcus aureus and Escherichia coli bacteremia: estimating the burden of antibiotic resistance in Europe. PLoS Med. 2011; 8(10):e1001104. PMC: 3191157. DOI: 10.1371/journal.pmed.1001104. View

18.

Brandt K, Sjoholm O, Krogh K, Halling-Sorensen B, Nybroe O . Increased pollution-induced bacterial community tolerance to sulfadiazine in soil hotspots amended with artificial root exudates. Environ Sci Technol. 2009; 43(8):2963-8. DOI: 10.1021/es803546y. View

19.

Helms M, Simonsen J, Molbak K . Quinolone resistance is associated with increased risk of invasive illness or death during infection with Salmonella serotype Typhimurium. J Infect Dis. 2004; 190(9):1652-4. DOI: 10.1086/424570. View

20.

Andersson D, Hughes D . Antibiotic resistance and its cost: is it possible to reverse resistance?. Nat Rev Microbiol. 2010; 8(4):260-71. DOI: 10.1038/nrmicro2319. View