Preprint Review Version 2 Preserved in Portico This version is not peer-reviewed

Systematic Review of Wastewater Surveillance of Antimicrobial Resistance in Human Populations

Version 1 : Received: 12 October 2020 / Approved: 13 October 2020 / Online: 13 October 2020 (09:36:11 CEST)
Version 2 : Received: 18 June 2021 / Approved: 21 June 2021 / Online: 21 June 2021 (11:25:51 CEST)

How to cite: Chau, K.; Barker, L.; Budgell, E.; Vihta, K.; Sims, N.; Kasprzyk-Hordern, B.; Harriss, E.; Crook, D.; Read, D.; Walker, S.; Stoesser, N. Systematic Review of Wastewater Surveillance of Antimicrobial Resistance in Human Populations. Preprints 2020, 2020100267 (doi: 10.20944/preprints202010.0267.v2). Chau, K.; Barker, L.; Budgell, E.; Vihta, K.; Sims, N.; Kasprzyk-Hordern, B.; Harriss, E.; Crook, D.; Read, D.; Walker, S.; Stoesser, N. Systematic Review of Wastewater Surveillance of Antimicrobial Resistance in Human Populations. Preprints 2020, 2020100267 (doi: 10.20944/preprints202010.0267.v2).

Abstract

We systematically reviewed studies using wastewater for AMR surveillance in human populations, to determine: (i) the strength of the evidence for a wastewater-human AMR association, and (ii) methodological approaches which optimised identifying such an association, and which could be recommended as standard. We used Lin’s concordance correlation coefficient (CCC) to quantify agreement between AMR prevalence in wastewater and human compartments, and logistic regression to identify study features (e.g. sampling methods) associated with high-agreement (defined as wastewater-human AMR prevalences within ±10%). Of 8,867 records and 232 full-text methods reviewed, 29 studies were included. AMR prevalence data was extractable from 20 studies conducting phenotypic-only (n=11), genotypic-only (n=1) or combined (n=8) AMR detection. Overall wastewater-human AMR concordance was reasonably high for both phenotypic (CCC=0.81 [95% CI 0.74-0.87]) and genotypic comparisons (CCC=0.88 (95% CI 0.85-0.91)) despite diverse species-phenotypes/genotypes and study design. Logistic regression was limited by inconsistent reporting of study features, and limited sample size; no significant relationships between study features and high wastewater-human AMR agreement were identified. Based on descriptive synthesis, composite/flow-proportional sampling of wastewater influent, longitudinal sampling >12 months, and time/location-matched comparisons generally had higher-agreement. Further research and clear and consistent reporting of study methods is required to confirm optimal practice.

Supplementary and Associated Material

Subject Areas

AMR; sewage; epidemiology; wastewater; surveillance

Comments (1)

Comment 1
Received: 21 June 2021
Commenter: Kevin Chau
Commenter's Conflict of Interests: Author
Comment: Version 2: Addition of new analyses using extracted AMR prevalence data from included studies. We have used Lin’s concordance coefficient to quantify agreement between AMR prevalence in wastewater and human compartments, and logistic regression to identify study features associated with higher agreement. This version has been extensively streamlined and rewritten to add new figures, results and discussion based on quantitative analyses to our comprehensive synthesis.
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