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Human health risk assessment (HHRA) for environmental development and transfer of antibiotic resistance
ASHBOLT, N., A. Amézquita, T. Backhaus, P. Borriello, K. Brandt, P. Collignon, A. Coors, R. Finley, W. Gaze, T. Heberer, J. Lawrence, J. Larsson, S. McEwen, J. Ryan, J. Schönfeld, P. Silley, J. Snape, C. van den Eede, AND E. Topp. Human health risk assessment (HHRA) for environmental development and transfer of antibiotic resistance. ENVIRONMENTAL HEALTH PERSPECTIVES. National Institute of Environmental Health Sciences (NIEHS), Research Triangle Park, NC, 121(9):993-1001, (2013).
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 environmental pathway risks. Here we present a review of issues and potential ways forward to undertake a HHRA for environmental antibiotic resistance that impacts of treatment failure of patients.
Objective: Here we present possible approaches and identify research needs to enable human health risk assessments that focus on the role the environment plays in antibiotic treatment failure of patients. Methods: The authors participated in a workshop sub-committee to define the scope and objectives of how to undertake 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 included accounting for the selective pressure in the presence of the antibiotic and resistome (dose) over some time period (exposure) for antibiotic resistant bacterial (ARB) development; identifying and describing rates of horizontal gene transfer in the relevant environmental ‘hot-spot’ compartments; and modifying traditional dose-response approaches to address doses of ARB for various health outcomes and pathways. Conclusions: In this paper we provide a proposal for the inclusion of environmental aspects of antibiotic resistance development in the processes of any HHRA addressing ARB. Due to limited available data a multi-criteria decision adding (MCDA) approach is suggested as a useful way forward to undertake a HHRA of environmental antibiotic resistance.