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Life sciences · Review
BMC Infectious Diseases · August 4, 2026
Well-designed and adequately powered for the question it asks.
This global systematic review and meta-analysis of 32 observational studies demonstrates a statistically significant association between environmental antimicrobial resistance contamination and human infectious disease outcomes (pooled OR 1.92, 95% CI 1.55–2.38). The authors emphasize this represents observational association only and does not establish causal transmission, but findings support enhanced environmental AMR surveillance and One Health control strategies.
Systematic review and meta-analysis of observational studies. Observational studies reporting quantitative associations between environmental antimicrobial resistance contamination and human infectious disease outcomes; global geographic coverage.. Intervention: Environmental antimicrobial resistance exposure. Compared with: No environmental AMR exposure (implicit comparison in observational studies). n = 32. Asia, Europe, Africa, and the Americas.
Pooled random-effects analysis: environmental AMR exposure associated with higher odds of human infectious disease outcomes (OR = 1.92, 95% CI: 1.55–2.38; p < 0.001) 32 studies met inclusion criteria for meta-analysis, covering evidence from Asia, Europe, Africa, and the Americas Subgroup analyses indicated variation across environmental compartments, with higher estimates observed in wastewater-related settings
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Clinicians and public health professionals should recognize environmental AMR contamination as a component of global AMR burden associated with human infectious disease risk, particularly in wastewater-exposed settings and lower-income regions. However, the observational nature of the evidence precludes inference of direct causal pathways; intervention trials and mechanistic studies are needed to establish causation and guide targeted control measures.
Systematic review and meta-analysis of 32 observational studies showing a consistent, statistically significant pooled association (OR 1.92, 95% CI 1.55–2.38, p<0.001) between environmental AMR and human infectious disease outcomes across multiple regions, though causality is not established.
As stated by the source record.
Quoted from the source exactly as published.
Clinicians and public health professionals should recognize environmental AMR contamination as a component of global AMR burden associated with human infectious disease risk, particularly in wastewater-exposed settings and lower-income regions. However, the observational nature of the evidence precludes inference of direct causal pathways; intervention trials and mechanistic studies are needed to establish causation and guide targeted control measures.
Graded across the dimensions that decide whether you should act, each from what the source actually supports. There is no single score, and where a dimension was not assessed it says so.
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.
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