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1.
  • Ashbolt, N. J., et al. (creator_code:aut_t)
  • Human Health Risk Assessment (HHRA) for Environmental Development and Transfer of Antibiotic Resistance
  • 2013
  • record:In_t: Environmental Health Perspectives. - : Environmental Health Perspectives. - 0091-6765 .- 1552-9924. ; 121:9, s. 993-1001
  • swepub:Mat_researchreview_t (swepub:level_refereed_t)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 anti-biotic treatment caused by antibiotic-resistant pathogens. METHODS: The authors participated in a workshop held 4-8 March 2012 in Quebec, 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.
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2.
  • Bengtsson-Palme, Johan, 1985, et al. (creator_code:aut_t)
  • Environmental factors influencing the development and spread of antibiotic resistance
  • 2018
  • record:In_t: FEMS Microbiology Reviews. - : Oxford University Press (OUP). - 0168-6445 .- 1574-6976. ; 42:1, s. 68-80
  • swepub:Mat_researchreview_t (swepub:level_refereed_t)abstract
    • Antibiotic resistance and its wider implications present us with a growing healthcare crisis. Recent research points to the environment as an important component for the transmission of resistant bacteria and in the emergence of resistant pathogens. However, a deeper understanding of the evolutionary and ecological processes that lead to clinical appearance of resistance genes is still lacking, as is knowledge of environmental dispersal barriers. This calls for better models of how resistance genes evolve, are mobilized, transferred and disseminated in the environment. Here, we attempt to define the ecological and evolutionary environmental factors that contribute to resistance development and transmission. Although mobilization of resistance genes likely occurs continuously, the great majority of such genetic events do not lead to the establishment of novel resistance factors in bacterial populations, unless there is a selection pressure for maintaining them or their fitness costs are negligible. To enable preventative measures it is therefore critical to investigate under what conditions and to what extent environmental selection for resistance takes place. In addition, understanding dispersal barriers is not only key to evaluate risks, but also to prevent resistant pathogens, as well as novel resistance genes, from reaching humans.
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3.
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4.
  • Finley, R. L., et al. (creator_code:aut_t)
  • The Scourge of Antibiotic Resistance: The Important Role of the Environment
  • 2013
  • record:In_t: Clinical Infectious Diseases. - : Oxford University Press (OUP). - 1058-4838 .- 1537-6591. ; 57:5, s. 704-710
  • swepub:Mat_researchreview_t (swepub:level_refereed_t)abstract
    • Antibiotic resistance and associated genes are ubiquitous and ancient, with most genes that encode resistance in human pathogens having originated in bacteria from the natural environment (eg, beta-lactamases and fluoroquinolones resistance genes, such as qnr). The rapid evolution and spread of "new" antibiotic resistance genes has been enhanced by modern human activity and its influence on the environmental resistome. This highlights the importance of including the role of the environmental vectors, such as bacterial genetic diversity within soil and water, in resistance risk management. We need to take more steps to decrease the spread of resistance genes in environmental bacteria into human pathogens, to decrease the spread of resistant bacteria to people and animals via foodstuffs, wastes and water, and to minimize the levels of antibiotics and antibiotic-resistant bacteria introduced into the environment. Reducing this risk must include improved management of waste containing antibiotic residues and antibiotic-resistant microorganisms.
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5.
  • Gaze, William H, et al. (creator_code:aut_t)
  • Influence of humans on evolution and mobilization of environmental antibiotic resistome.
  • 2013
  • record:In_t: Emerging infectious diseases. - : Centers for Disease Control and Prevention (CDC). - 1080-6059 .- 1080-6040. ; 19:7
  • swepub:Mat_researchreview_t (swepub:level_refereed_t)abstract
    • The clinical failure of antimicrobial drugs that were previously effective in controlling infectious disease is a tragedy of increasing magnitude that gravely affects human health. This resistance by pathogens is often the endpoint of an evolutionary process that began billions of years ago in non-disease-causing microorganisms. This environmental resistome, its mobilization, and the conditions that facilitate its entry into human pathogens are at the heart of the current public health crisis in antibiotic resistance. Understanding the origins, evolution, and mechanisms of transfer of resistance elements is vital to our ability to adequately address this public health issue.
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6.
  • Larsson, D. G. Joakim, 1969 (creator_code:aut_t)
  • Antibiotics in the environment
  • 2014
  • record:In_t: Upsala Journal of Medical Sciences. - : Uppsala Medical Society. - 0300-9734 .- 2000-1967. ; 119:2, s. 108-112
  • swepub:Mat_researchreview_t (swepub:level_refereed_t)abstract
    • Molecules with antibiotic properties, produced by various microbes, have been around long before mankind recognized their usefulness in preventing and treating bacterial infections. Bacteria have therefore been exposed to selection pressures from antibiotics for very long times, however, generally only on a micro-scale within the immediate vicinity of the antibiotic-producing organisms. In the twentieth century we began mass-producing antibiotics, mainly synthetic derivatives of naturally produced antibiotic molecules, but also a few entirely synthetic compounds. As a consequence, entire bacterial communities became exposed to unprecedented antibiotic selection pressures, which in turn led to the rapid resistance development we are facing today among many pathogens. We are, rightly, concerned about the direct selection pressures of antibiotics on the microbial communities that reside in or on our bodies. However, other environments, outside of our bodies, may also be exposed to antibiotics through different routes, most often unintentionally. There are concerns that increased selection pressures from antibiotics in the environment can contribute to the recruitment of resistance factors from the environmental resistome to human pathogens. This paper attempts to 1) provide a brief overview of environmental exposure routes of antibiotics, 2) provide some thoughts about our current knowledge of the associated risks for humans as well as ecosystems, and 3) indicate management options to reduce risks.
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7.
  • Larsson, D. G. Joakim, 1969, et al. (creator_code:aut_t)
  • Bra läkemedel på fel plats kan påverka naturen och ge resistens : Great drugs in the wrong place: risks for environmental effects and resistance promotion
  • 2014
  • record:In_t: Läkartidningen. - 0023-7205. ; 111:CPP3:14, s. 619-20
  • swepub:Mat_researchreview_t (swepub:level_refereed_t)abstract
    • Low concentrations of pharmaceuticals reach the environment through usage and excretion. Most of these do probably not reach sufficient levels to affect wildlife, but a few do. Some drugs are consequently also detected in tap water, but given the extremely low concentrations, risks for direct effects on humans are currently considered negligible. Much higher environmental discharges of pharmaceuticals are found at certain manufacturing sites. Of particular concern for human health are environmental pollution with antibiotics that can promote the development and spread of antibiotic-resistant bacteria. More effective effluent treatment is in many cases an option for management, but economic incentives are key for sparking ini­tiatives. For the management of antibiotic resistance a »one-health-concept« is advised, including prudent use in human and veterinary medicine, as well as minimizing environ­mental discharges.
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8.
  • Larsson, D. G. Joakim, 1969, et al. (creator_code:aut_t)
  • Critical knowledge gaps and research needs related to the environmental dimensions of antibiotic resistance
  • 2018
  • record:In_t: Environment International. - : Elsevier BV. - 0160-4120 .- 1873-6750. ; 117, s. 132-138
  • swepub:Mat_researchreview_t (swepub:level_refereed_t)abstract
    • There is growing understanding that the environment plays an important role both in the transmission of antibiotic resistant pathogens and in their evolution. Accordingly, researchers and stakeholders world-wide seek to further explore the mechanisms and drivers involved, quantify risks and identify suitable interventions. There is a clear value in establishing research needs and coordinating efforts within and across nations in order to best tackle this global challenge. At an international workshop in late September 2017, scientists from 14 countries with expertise on the environmental dimensions of antibiotic resistance gathered to define critical knowledge gaps. Four key areas were identified where research is urgently needed: 1) the relative contributions of different sources of antibiotics and antibiotic resistant bacteria into the environment; 2) the role of the environment, and particularly anthropogenic inputs, in the evolution of resistance; 3) the overall human and animal health impacts caused by exposure to environmental resistant bacteria; and 4) the efficacy and feasibility of different technological, social, economic and behavioral interventions to mitigate environmental antibiotic resistance.(1)
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9.
  • Larsson, D. G. Joakim, 1969, et al. (creator_code:aut_t)
  • Läkemedel i miljön
  • 2011
  • record:In_t: Läkemedelsboken 2011-2012. ; , s. 1182-1193
  • swepub:Mat_researchreview_t (swepub:level_refereed_t)
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10.
  • Larsson, D. G. Joakim, 1969, et al. (creator_code:aut_t)
  • Läkemedel i miljön
  • 2014
  • record:In_t: Läkemedelsboken 2014. ; , s. 1267-1279
  • swepub:Mat_researchreview_t (swepub:level_refereed_t)
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