Antibiotic resistance is a major concern for public and environmental health. The role played by the environment in disseminating resistance is increasingly considered, as well as its capacity for mitigation. We reviewed the literature on strategies to control dissemination of antibiotic-resistant bacteria (ARB), antibiotic resistance genes (ARG) and mobile genetic elements (MGE) in the environment. This systematic review focused on three main strategies: (i) restriction of antibiotic use (S1), (ii) treatments of liquid/solid matrices (S2) and (iii) management of natural environment (S3). Articles were collected from seven scientific databases until July 2017 and from Web of Science until June 2018. Only studies reporting measurements of ARB, ARG or MGE in environmental samples were included. An evidence map was drawn from metadata extracted from all studies eligible for S1, S2 and S3. Subsets of studies were assessed for internal and external validity to perform narrative and quantitative syntheses. A meta-analysis was carried out to assess the effects of organic waste treatments (random-effect models). Nine hundred and thirty-one articles representing 1316 individual studies (n) were eligible for S1 (n = 59), S2 (n = 781) and S3 (n = 476) strategies, respectively. Effects of interventions to control the dissemination of antibiotic resistance in the environment were primarily studied in strategy S2. A partial efficiency of wastewater treatment plants (WWTPs) to reduce antibiotic resistance in treated effluent was reported in 118 high validity studies. In spite of the heterogeneity in published results, the meta-analysis showed that composting and drying were efficient treatments to reduce the relative abundance of ARG and MGE in organic waste, by 84% [65%; 93%] and 98% [80%; 100%], respectively. The effect of anaerobic digestion was not statistically significant (51% reduction [− 2%; 77%]) when organic waste treatments were compared together in the same model. Studies in strategies S1 and S3 mainly assessed the effects of exposure to sources of contamination. For instance, 28 medium/high validity studies showed an increase of antibiotic resistance in aquatic environments at the WWTP discharge point. Some of these studies also showed a decrease of resistance as the distance from the WWTP increases, related to a natural resilience capacity of aquatic environments. Concerning wildlife, nine medium/high validity studies showed that animals exposed to anthropogenic activities carried more ARB. Knowledge gaps were identified for the relationship between restriction of antibiotic use and variation of antibiotic resistance in the environment, as well as on possible interventions in situ in natural environment. Organic waste treatments with thermophilic phase (> 50 °C) should be implemented before the use/release of organic waste in the environment. More investigation should be conducted with the datasets available in this review to determine the treatment efficiency on ARG carried by specific bacterial communities.

中文翻译：

---

控制环境中抗药性传播的策略效果如何？系统评价

抗生素抗性是公共和环境健康的主要关注点。人们越来越多地考虑到环境在传播抵抗中的作用及其缓解能力。我们回顾了有关控制环境中抗生素抗性细菌（ARB），抗生素抗性基因（ARG）和移动遗传元件（MGE）传播的策略的文献。这项系统的审查集中在三个主要策略上：（i）限制抗生素的使用（S1），（ii）液体/固体基质的处理（S2）和（iii）自然环境的管理（S3）。截至2017年7月，文章收集自七个科学数据库；截至2018年6月，文章收集自Web of Science。仅包括报告环境样品中ARB，ARG或MGE测量值的研究。从从符合S1，S2和S3的所有研究中提取的元数据绘制证据图。评估研究的子集的内部和外部有效性，以进行叙述和定量综合。进行了荟萃分析，以评估有机废物处理的效果（随机效应模型）。代表1316项独立研究（n）的993篇文章分别符合S1（n = 59），S2（n = 781）和S3（n = 476）策略。策略S2中主要研究了控制环境中抗药性传播的干预措施的效果。118个高有效性研究报告了废水处理厂（WWTP）降低处理后的废水中的抗生素抗性的部分效率。尽管发表的结果存在异质性，荟萃分析表明，堆肥和干燥是将有机废物中ARG和MGE的相对丰度降低84％[65％；93％]和98％[80％；100％]。当在同一模型中将有机废物处理进行比较时，厌氧消化的效果没有统计学意义（减少51％[-2％； 77％]）。策略S1和S3的研究主要评估暴露于污染源的影响。例如，有28项中/高有效性研究表明，在WWTP排放点的水生环境中，抗生素耐药性增加。这些研究中的一些研究还表明，随着与WWTP距离的增加，抗性降低，这与水生环境的自然适应能力有关。关于野生动植物 九项中/高有效性研究表明，暴露于人为活动的动物携带更多的ARB。在环境中抗生素使用的限制与抗生素耐药性变化之间的关系以及在自然环境中可能采取的干预措施之间的关系，已经确定了知识差距。在环境中使用/释放有机废物之前，应实施具有高温相（> 50°C）的有机废物处理。应使用本综述中的可用数据集进行更多调查，以确定特定细菌群落对ARG的治疗效率。以及在自然环境中可能采取的干预措施。在环境中使用/释放有机废物之前，应实施具有高温相（> 50°C）的有机废物处理。应使用本综述中的可用数据集进行更多调查，以确定特定细菌群落对ARG的治疗效率。以及在自然环境中可能采取的干预措施。在环境中使用/释放有机废物之前，应先进行具有高温相（> 50°C）的有机废物处理。应使用本综述中的可用数据集进行更多调查，以确定特定细菌群落对ARG的治疗效率。