BACKGROUND Antibiotic resistance is a global public health threat. Water from human activities is collected at wastewater treatment plants where processes often do not sufficiently neutralize antibiotic resistant bacteria and genes, which are further shed into the local environment. This protocol outlines the steps to conduct a systematic review based on the Population, Exposure, Comparator and Outcome (PECO) framework, aiming at answering the question "Are antimicrobial-resistant enterobacteriaceae and antimicrobial resistance genes present (O) in air and water samples (P) taken either near or downstream or downwind or down-gradient from wastewater treatment plants (E), as compared to air and water samples taken either further away or upstream or upwind or up-gradient from such wastewater treatment plant (C)?" Presence of antimicrobial-resistant bacteria and genes will be quantitatively measured by extracting their prevalence or concentration, depending on the reviewed study. METHODS We will search PubMed, EMBASE, the Cochrane database and Web of Science for original articles published from 1 Jan 2000 to 3 Sep 2018 with language restriction. Articles will undergo a relevance and a design screening process. Data from eligible articles will be extracted by two independent reviewers. Further, we will perform a risk of bias assessment using a decision matrix. We will synthesize and present results in narrative and tabular form and will perform a meta-analysis if heterogeneity of results allows it. DISCUSSION Antibiotic resistance in environmental samples around wastewater treatment plants may pose a risk of exposure to workers and nearby residents. Results from the systematic review outlined in this protocol will allow to estimate the extend of exposure, to inform policy making and help to design future studies.

中文翻译：

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废水处理厂是否会增加环境中的抗生素抗性细菌或基因？进行系统审查的协议。

背景技术抗生素抗性是全球公共卫生威胁。来自人类活动的水被收集到废水处理厂，在这些厂中，处理过程通常不能充分中和对抗生素具有抗性的细菌和基因，这些细菌和基因会进一步散布到当地环境中。该协议概述了基于种群，暴露，比较者和结果（PECO）框架进行系统评价的步骤，旨在回答以下问题：“空气和水样品中是否存在抗药性肠杆菌科细菌和抗药性基因（O）（ P）是从废水处理厂（E）的附近，下游，顺风或下坡采集的，与从该废水处理厂（C）的上游，上风或上坡或向上采集的空气和水样相比？” 取决于所审查的研究，将通过提取其耐药性和浓度来定量测量其耐药性细菌和基因的存在。方法我们将在PubMed，EMBASE，Cochrane数据库和Web of Science中搜索2000年1月1日至2018年9月3日发表的具有语言限制的原始文章。文章将进行相关性和设计筛选过程。来自合格文章的数据将由两名独立的审阅者提取。此外，我们将使用决策矩阵进行偏差评估的风险。如果结果的异质性允许，我们将以叙述和表格的形式综合并呈现结果，并将进行荟萃分析。讨论废水处理厂周围环境样品中的抗生素抗性可能会导致工人和附近居民接触的风险。