Table 1 Eligibility criteria for Map 1
| Â | Inclusion | Exclusion | Justification |
|---|---|---|---|
Population | Adults, Children | Non-humans (e.g. animals, plants) | Evidence of ARB/ARG transmission to humans from the environment is of interest to relevant stakeholders |
Exposure sources | Meat from wild animals, including shellfish (bivalve molluscs, lobster, crab, etc.), fin fish, game) | Meat and animal products from commercially produced animals including fish, shellfish (including shrimp), poultry (including pheasants), pigs, cows, sheep etc., and products including honey, milk, eggs) | While food is produced in the environment, practices during commercial production and processing (e.g. antibiotic use, through poor hygiene in preparation and handling of food) might be the sources of ARB, rather than from the environment Wild animals consumed for their meat are of interest as sources of AMR are more likely to be from the environment. Bivalve molluscs are grown in the environment and are filter-feeders, concentrating contaminants in the environment, and this meat is typically eaten raw or lightly cooked. Shrimp are intensively raised in some parts of the world, and antibiotic usage is poorly regulated. Likewise, pheasants are reared on high levels of antibiotics and then released into the environment [81] |
Plants that are consumed raw (including salad, fruit etc.) | Plants that are always consumed cooked (including grains etc.) | Plants consumed raw pose are more likely to result in transmission of ARB from plants to humans | |
Water in the environment (including water used in crop irrigation; aquaculture; ambient surface waters used for recreation; drinking water and wastewater from domestic and industrial sources) | Water from chlorinated swimming pools and spas | Water in swimming pools and spas are treated to remove pathogenic microorganisms, and are not considered the environment | |
Soil including that conditioned with faecal matter (sludge/slurry/manure etc. or irrigated with waste water). Exposure may be through activities such as farming, gardening, leisure activities such as playing etc.) | N/A | Â | |
Outdoor air (may contain dust, water droplets etc.) | Studies that have collected air from indoor environments | ARB/ARGs in outdoor environment are more likely to be from natural sources | |
Contact with animals or their faeces | Pets, companion animals and commercially produced livestock | ARB/ARGs in/on wild animals are more likely to be from the environment. Those on pets, companion animals and commercially produced animals might be due to antimicrobial usage during animal rearing, for example raw food diet in companion animals is associated with carriage of ARB [82]. Exposure and transmission from pets, companion animals and commercially produced livestock are not of specific interest to relevant stakeholders | |
Exposure routes | Consumption/ingestion; Inhalation Direct contact | Â | Â |
Outcomes | Mortality caused by infection with ARB, bacteria harbouring ARG(s) or bacteria harbouring intI1/Class 1 integron - Infection with ARB, bacteria harbouring ARG(s) or bacteria harbouring intI1/Class 1 integron - Colonisation by ARB, bacteria harbouring ARG(s) or bacteria harbouring intI1/Class 1 integron - Estimated or measured risk of exposure to ARB, bacteria harbouring ARG(s) or bacteria harbouring intI1/Class 1 integron | Infections caused by fungi, parasites or viruses | While fungal, parasitic and viral infections resistant to antimicrobials are of interest to relevant stakeholders, ARB are a priority for regulators Resource constraints mean other types of AMR organisms will not be included Although this is not a human health outcome it represents this risk of exposure that could result in a human health outcome and is, therefore, deemed important to include |