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<p>Environmental antimicrobial resistance (AMR) is increasingly recognized as a key component of the global AMR burden and may be associated with human infectious disease outcomes through complex ecological exposure pathways. However, the overall magnitude and consistency of this relationship across environmental compartments and regions remain insufficiently quantified. This study systematically synthesized observational evidence on the association between environmental AMR contamination and human infectious disease outcomes within a global One Health framework. A systematic review and meta-analysis were conducted following PRISMA 2020 guidelines. Major databases, including PubMed/MEDLINE, Scopus, Web of Science, and Embase, were searched from January 2000 to March 2025. Eligible studies included in the review were published between 2005 and 2025. Observational studies reporting quantitative associations between environmental AMR exposure and human infectious disease outcomes were included. In total, 1,842 records were identified, and 32 studies met the inclusion criteria for meta-analysis, covering evidence from Asia, Europe, Africa, and the Americas. The pooled random-effects analysis showed that environmental AMR exposure was significantly associated with higher odds of human infectious disease outcomes (OR = 1.92, 95% CI: 1.55–2.38; <i>p</i> &lt; 0.001). Subgroup analyses indicated variation across environmental compartments, with higher estimates observed in wastewater-related settings. Stronger associations were also observed in low- and middle-income countries compared with high-income countries. Overall, environmental AMR exposure shows a consistent positive association with human infectious disease outcomes across diverse settings. However, these findings represent observational associations and do not imply direct causal transmission. The results support strengthening environmental AMR surveillance and integrating environmental compartments into One Health antimicrobial resistance control strategies.</p>

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Environmental antimicrobial resistance and human infectious disease outcomes: a global one health systematic review and meta-analysis of observational studies

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年8月4日

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  • Gebre Ayanaw Alula,
  • Shegasew Tessema

摘要

Environmental antimicrobial resistance (AMR) is increasingly recognized as a key component of the global AMR burden and may be associated with human infectious disease outcomes through complex ecological exposure pathways. However, the overall magnitude and consistency of this relationship across environmental compartments and regions remain insufficiently quantified. This study systematically synthesized observational evidence on the association between environmental AMR contamination and human infectious disease outcomes within a global One Health framework. A systematic review and meta-analysis were conducted following PRISMA 2020 guidelines. Major databases, including PubMed/MEDLINE, Scopus, Web of Science, and Embase, were searched from January 2000 to March 2025. Eligible studies included in the review were published between 2005 and 2025. Observational studies reporting quantitative associations between environmental AMR exposure and human infectious disease outcomes were included. In total, 1,842 records were identified, and 32 studies met the inclusion criteria for meta-analysis, covering evidence from Asia, Europe, Africa, and the Americas. The pooled random-effects analysis showed that environmental AMR exposure was significantly associated with higher odds of human infectious disease outcomes (OR = 1.92, 95% CI: 1.55–2.38; p < 0.001). Subgroup analyses indicated variation across environmental compartments, with higher estimates observed in wastewater-related settings. Stronger associations were also observed in low- and middle-income countries compared with high-income countries. Overall, environmental AMR exposure shows a consistent positive association with human infectious disease outcomes across diverse settings. However, these findings represent observational associations and do not imply direct causal transmission. The results support strengthening environmental AMR surveillance and integrating environmental compartments into One Health antimicrobial resistance control strategies.