Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
Department of Mathematics, Faculty of Sciences, Utrecht University, Utrecht, The Netherlands.
BMC Infect Dis. 2022 May 20;22(1):482. doi: 10.1186/s12879-022-07360-z.
Quantification of acquisition routes of antibiotic resistant bacteria (ARB) is pivotal for understanding transmission dynamics and designing cost-effective interventions. Different methods have been used to quantify the importance of transmission routes, such as relative risks, odds ratios (OR), genomic comparisons and basic reproduction numbers. We systematically reviewed reported estimates on acquisition routes' contributions of ARB in humans, animals, water and the environment and assessed the methods used to quantify the importance of transmission routes.
PubMed and EMBASE were searched, resulting in 6054 articles published up until January 1st, 2019. Full text screening was performed on 525 articles and 277 are included.
We extracted 718 estimates with S. aureus (n = 273), E. coli (n = 157) and Enterobacteriaceae (n = 99) being studied most frequently. Most estimates were derived from statistical methods (n = 560), mainly expressed as risks (n = 246) and ORs (n = 239), followed by genetic comparisons (n = 85), modelling (n = 62) and dosage of ARB ingested (n = 17). Transmission routes analysed most frequently were occupational exposure (n = 157), travelling (n = 110) and contacts with carriers (n = 83). Studies were mostly performed in the United States (n = 142), the Netherlands (n = 87) and Germany (n = 60). Comparison of methods was not possible as studies using different methods to estimate the same route were lacking. Due to study heterogeneity not all estimates by the same method could be pooled.
Despite an abundance of published data the relative importance of transmission routes of ARB has not been accurately quantified. Links between exposure and acquisition are often present, but the frequency of exposure is missing, which disables estimation of transmission routes' importance. To create effective policies reducing ARB, estimates of transmission should be weighed by the frequency of exposure occurrence.
量化抗生素耐药菌（ARB）的获得途径对于理解传播动态和设计具有成本效益的干预措施至关重要。已经使用了不同的方法来量化传播途径的重要性，例如相对风险、比值比（OR）、基因组比较和基本繁殖数。我们系统地回顾了报告中关于人类、动物、水和环境中 ARB 获得途径的贡献的估计，并评估了用于量化传播途径重要性的方法。
在 PubMed 和 EMBASE 上进行了搜索，截至 2019 年 1 月 1 日共检索到 6054 篇文章。对 525 篇文章进行了全文筛选，其中 277 篇被纳入。
我们提取了 718 个估计值，其中金黄色葡萄球菌（n=273）、大肠杆菌（n=157）和肠杆菌科（n=99）的研究最为频繁。大多数估计值来自统计方法（n=560），主要以风险（n=246）和比值比（n=239）表示，其次是遗传比较（n=85）、建模（n=62）和摄入的 ARB 剂量（n=17）。分析最多的传播途径是职业暴露（n=157）、旅行（n=110）和与携带者接触（n=83）。研究主要在美国（n=142）、荷兰（n=87）和德国（n=60）进行。由于缺乏使用不同方法估计相同途径的研究，因此无法比较方法。由于研究的异质性，并非所有使用相同方法的估计值都可以合并。
尽管发表了大量数据，但 ARB 传播途径的相对重要性尚未得到准确量化。暴露与获得之间的联系经常存在，但缺乏暴露的频率，这使得传播途径重要性的估计变得不可能。为了制定减少 ARB 的有效政策，应根据暴露发生的频率来权衡传播估计值。
