Directional spillover of antimicrobial-resistant bacteria from animal, food-production and environmental reservoirs to humans: protocol for a systematic scoping review and causal evidence assessment
10 affiliations
- 1OUCRU, Hanoi, Vietnam
- 2Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
- 3Utrecht University, Utrecht, The Netherlands
- 4One Health Trust, Sivanchetti Gardens, Bengaluru, India
- 5Max Institute of Healthcare Management, Indian School of Business, Hyderabad, India
- 6Economics, One Health Trust India, Bengaluru, India
- 7Nuffield Department of Clinical Medicine, University of Oxford, Oxford, Oxfordshire, UK
- 8Nuffield Centre for International Health and Development, University of Leeds, Leeds, UK
- 9National Center for Water Resources Planning and Investigation, Hanoi, Vietnam
- 10Tropical Agricultural Research and Higher Education Centre (CATIE), Turrialba, Cartago, Costa Rica
Abstract
Introduction: Transmission of antimicrobial-resistant bacteria from animal, food-production and environmental reservoirs to humans underpins One Health policy, yet the causal evidence has not been systematically assessed. Molecular similarity is often invoked as evidence of transmission, but shared resistance determinants cannot establish the direction of transfer. This review will identify and classify evidence on antimicrobial resistance transmission from these reservoirs to humans, generate an evidence map by reservoir category and transmission pathway and identify gaps where policy assumptions outpace empirical support.
Methods and analysis: This systematic scoping review will be reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). We searched MEDLINE, Embase, Web of Science, Scopus, Global Health and China National Knowledge Infrastructure from 2000 onwards (initial search 16 July 2026; supplementary search 20 September 2026), supplemented by grey literature and citation tracking. Studies linking these reservoirs to human colonisation or infection with antimicrobial-resistant bacteria will be eligible. Records will be screened in duplicate in Rayyan with AI-assisted prioritisation (MetaScreener). Two reviewers will independently assess causal support using a framework integrating evidence type, directionality and level assignment, informed by Grading of Recommendations Assessment, Development and Evalution (GRADE) principles and Bradford Hill criteria. Strain-level and gene-level evidence (including metagenomic signals) will be distinguished, and colonisation and infection will be coded as parallel outcomes. The primary output will be a 9×5 evidence map crossing reservoir categories with transmission pathways, showing the highest causal support level, study counts and directionality for each combination.
Ethics and dissemination: This review analyses existing published data; ethical approval is not required. Findings will be submitted to a peer-reviewed open-access journal, presented at conferences and summarised as briefing materials for One Health policy bodies. The evidence map, extraction dataset and analytic code will be made publicly available through the Open Science Framework (OSF).
Registration: This protocol is registered on the OSF; registration Digital Object Identifier (DOI): 10.17605/OSF.IO/KQVDC.
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BibTeX
@article{hong2026directional,
title = {{Directional spillover of antimicrobial-resistant bacteria from animal, food-production and environmental reservoirs to humans: protocol for a systematic scoping review and causal evidence assessment}},
author = {Chaokun Hong and Thao Phuong Nguyen and Hai Huan Hoang Ngo and Ha Thanh Le and Trang Thu Vu and Max van Wijk and Srikanth Reddy Umenthala and Deepshikha Batheja and Rachel Otuko and Soe Yu Naing and Jaap Wagenaar and Ben Cooper and Thomas Kesteman and Rogier van Doorn and Kelly Moon and Duong Du Bui and Pablo Imbach and Sonia Lewycka},
journal = {BMJ Open},
year = {2026},
month = oct,
doi = {10.1136/bmjopen-2026-125301},
url = {https://bmjopen.bmj.com/lookup/doi/10.1136/bmjopen-2026-125301},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - Directional spillover of antimicrobial-resistant bacteria from animal, food-production and environmental reservoirs to humans: protocol for a systematic scoping review and causal evidence assessment
AU - Chaokun Hong
AU - Thao Phuong Nguyen
AU - Hai Huan Hoang Ngo
AU - Ha Thanh Le
AU - Trang Thu Vu
AU - Max van Wijk
AU - Srikanth Reddy Umenthala
AU - Deepshikha Batheja
AU - Rachel Otuko
AU - Soe Yu Naing
AU - Jaap Wagenaar
AU - Ben Cooper
AU - Thomas Kesteman
AU - Rogier van Doorn
AU - Kelly Moon
AU - Duong Du Bui
AU - Pablo Imbach
AU - Sonia Lewycka
PY - 2026
DA - 2026/10/30
JO - BMJ Open
DO - 10.1136/bmjopen-2026-125301
UR - https://bmjopen.bmj.com/lookup/doi/10.1136/bmjopen-2026-125301
AB - Introduction: Transmission of antimicrobial-resistant bacteria from animal, food-production and environmental reservoirs to humans underpins One Health policy, yet the causal evidence has not been systematically assessed. Molecular similarity is often invoked as evidence of transmission, but shared resistance determinants cannot establish the direction of transfer. This review will identify and classify evidence on antimicrobial resistance transmission from these reservoirs to humans, generate an evidence map by reservoir category and transmission pathway and identify gaps where policy assumptions outpace empirical support. Methods and analysis: This systematic scoping review will be reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). We searched MEDLINE, Embase, Web of Science, Scopus, Global Health and China National Knowledge Infrastructure from 2000 onwards (initial search 16 July 2026; supplementary search 20 September 2026), supplemented by grey literature and citation tracking. Studies linking these reservoirs to human colonisation or infection with antimicrobial-resistant bacteria will be eligible. Records will be screened in duplicate in Rayyan with AI-assisted prioritisation (MetaScreener). Two reviewers will independently assess causal support using a framework integrating evidence type, directionality and level assignment, informed by Grading of Recommendations Assessment, Development and Evalution (GRADE) principles and Bradford Hill criteria. Strain-level and gene-level evidence (including metagenomic signals) will be distinguished, and colonisation and infection will be coded as parallel outcomes. The primary output will be a 9×5 evidence map crossing reservoir categories with transmission pathways, showing the highest causal support level, study counts and directionality for each combination. Ethics and dissemination: This review analyses existing published data; ethical approval is not required. Findings will be submitted to a peer-reviewed open-access journal, presented at conferences and summarised as briefing materials for One Health policy bodies. The evidence map, extraction dataset and analytic code will be made publicly available through the Open Science Framework (OSF). Registration: This protocol is registered on the OSF; registration Digital Object Identifier (DOI): 10.17605/OSF.IO/KQVDC.
SN - 2044-6055
SN - 2044-6055
ER -