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Review
. 2013 Sep;121(9):993-1001.
doi: 10.1289/ehp.1206316. Epub 2013 Jul 9.

Human Health Risk Assessment (HHRA) for environmental development and transfer of antibiotic resistance

Nicholas J Ashbolt  1 , Alejandro Amézquita, Thomas Backhaus, Peter Borriello, Kristian K Brandt, Peter Collignon, Anja Coors, Rita Finley, William H Gaze, Thomas Heberer, John R Lawrence, D G Joakim Larsson, Scott A McEwen, James J Ryan, Jens Schönfeld, Peter Silley, Jason R Snape, Christel Van den Eede, Edward Topp
Affiliations
Review

Human Health Risk Assessment (HHRA) for environmental development and transfer of antibiotic resistance

Nicholas J Ashbolt et al. Environ Health Perspect. 2013 Sep.

Abstract

Background: 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 risks.

Objective: We examined possible approaches and sought to identify research needs to enable human health risk assessments (HHRA) that focus on the role of the environment in the failure of antibiotic treatment caused by antibiotic-resistant pathogens.

Methods: The authors participated in a workshop held 4-8 March 2012 in Québec, Canada, to define the scope and objectives of 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 include a) accounting for an added selective pressure on the environmental resistome that, over time, allows for development of antibiotic-resistant bacteria (ARB); b) identifying and describing rates of horizontal gene transfer (HGT) in the relevant environmental "hot spot" compartments; and c) modifying traditional dose-response approaches to address doses of ARB for various health outcomes and pathways.

Conclusions: We propose that environmental aspects of antibiotic-resistance development be included in the processes of any HHRA addressing ARB. Because of limited available data, a multicriteria decision analysis approach would be a useful way to undertake an HHRA of environmental antibiotic resistance that informs risk managers.

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Conflict of interest statement

The views expressed in this article are those of the authors and do not necessarily represent the views or policies of the U.S. Environmental Protection Agency.

P.S. and A.C. have provided consultancy services to the pharmaceutical industry. A.A., C.V.D.E., J.J.R., and J.R.S. are employed by the pharmaceutical and personal care products sector. T.B., K.K.B., P.C., A.C., W.H.G., J.R.L., D.G.J.L., S.A.M., and E.T. have received funding from industry or government for research on pharmaceutical issues. J.R.S. has shareholdings in the pharmaceutical sector. N.J.A., T.H., R.F., P.B., and J.S. declare they have no actual or potential competing financial interests.

Figures

Figure 1
Figure 1
Conceptual model describing the environmental pathways that result in an increased risk of human and animal infection with antibiotic-resistant bacteria. Processes 1–6 are further described in the text. Because processes 7 and 8 are not driven by environmental factors, they are not discussed in detail.
See this image and copyright information in PMC

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