Background: Antimicrobial resistance (AMR) is a public health crisis that is predicted to cause 10 million deaths per
year by 2050. The environment has been implicated as a reservoir of AMR and is suggested to play a role in the dissemination of antibiotic resistance genes (ARGs). Currently, most research has focused on measuring ...
Background: Antimicrobial resistance (AMR) is a public health crisis that is predicted to cause 10 million deaths per
year by 2050. The environment has been implicated as a reservoir of AMR and is suggested to play a role in the dissemination of antibiotic resistance genes (ARGs). Currently, most research has focused on measuring concentrations
of antibiotics and characterising the abundance and diversity of ARGs and antibiotic resistant bacteria (ARB) in the
environment. To date, there has been limited empirical research on whether humans are exposed to this, and whether
exposure can lead to measureable impacts on human health. Therefore, the objective of this work is to produce two
linked systematic maps to investigate previous research on exposure and transmission of AMR to humans from the
environment. The frst map will investigate the available research relating to exposure and transmission of ARB/ARGs
from the environment to humans on a global scale and the second will investigate the prevalence of ARB/ARGs in
various environments in the UK. These two maps will be useful for policy makers and research funders to identify
where there are signifcant gluts and gaps in the current research, and where more primary and synthesis research
needs to be undertaken.
Methods: Separate search strategies will be developed for the two maps. Searches will be run in 13 databases, and
grey literature will be sought from key websites and engagement with experts. Hits will be managed in EndNote and
screened in two stages (title/abstract then full text) against predefned inclusion criteria. A minimum of 10% will be
double screened with ongoing consistency checking. All included studies will have data extracted into a bespoke
form designed and piloted for each map. Data to be extracted will include bibliographic details, study design, location, exposure source, exposure route, health outcome (Map 1); and prevalence/percentage of ARB/ARG (Map 2).
No validity appraisal will be undertaken. Results will be tabulated and presented narratively, together with graphics
showing the types and areas of research that has been undertaken and heatmaps for key exposure-health outcomes
(Map 1) and exposure-prevalence (Map 2).
