What are the effective solutions to control the dissemination of antibiotic resistance in the environment? A systematic review protocol

Background Antibiotic treatments are indispensable for human and animal health. However, the heavy usage of antibiotics has led to the emergence of resistance. Antibiotic residues, antibiotic-resistant bacteria and genes are introduced into the terrestrial and aquatic environments via application of human and animal wastes. The emergence and the spread of antibiotic resistance in environmental reservoirs (i.e., soil, water, wildlife) threatens the efficacy of all antibiotics. Therefore, there is an urgent need to determine what effective solutions exist to minimize the dissemination of antibiotic resistance in the environment. The aim of this article is to describe the protocol of a systematic review of the literature considering these solutions. Methods The primary questions addressed by the systematic review protocol are: how antibiotic resistance in the environment is impacted by changes in practice concerning (i) the use of antibiotics, (ii) the management of wastes or (iii) the management of the natural compartment. Bibliographic searches will be made in eleven publication databases as well as in specialist databases. Grey literature will also be searched. Articles will be screened regarding the inclusion and exclusion criteria at title, abstract and full-text levels. Studies where a causal relationship between the intervention and the outcome is made will be retained. After critical appraisal, data from the selected articles will be extracted and saved in a database validated by the expert panel. Study quality will be assessed by critical appraisal. Data will be compiled into a qualitative synthesis. If data availability and quality allow it, a quantitative synthesis will be carried out.