EMBRACE-WATERS statement: Recommendations for reporting of studies on antimicrobial resistance in wastewater and related aquatic environments
Nasreen Hassoun-Kheir,
Yoav Stabholz,
Jan-Ulrich Kreft,
Roberto de la Cruz,
Arnaud Dechesne,
Barth F. Smets,
Jesús L. Romalde,
Alberto Lema,
Sabela Balboa,
Carlos García-Riestra,
Eva Torres-Sangiao,
Ami Neuberger,
David Graham,
Marcos Quintela-Baluja,
Dov J. Stekel,
Jay Graham,
Amy Pruden,
Joseph Nesme,
Søren Johannes Sørensen,
Rupert Hough,
Mical Paul
Affiliations
Nasreen Hassoun-Kheir
Infectious Diseases Institute, Rambam Health Care Campus, HaAliya HaShniya St 8, Haifa 3109601, Israel; The Ruth and Bruce Rappaport Faculty of Medicine, Technion – Israel Institute of Technology, Efron St 1, Haifa 3109601, Israel; Corresponding author at: Infectious Diseases Institute, Rambam Health Care Campus, HaAliya HaShniya St 8, Haifa 3109601, Israel.
Yoav Stabholz
Infectious Diseases Institute, Rambam Health Care Campus, HaAliya HaShniya St 8, Haifa 3109601, Israel
Jan-Ulrich Kreft
School of Biosciences, Institute of Microbiology and Infection (IMI), Centre for Computational Biology (CCB), University of Birmingham, Birmingham, UK
Roberto de la Cruz
School of Biosciences, Institute of Microbiology and Infection (IMI), Centre for Computational Biology (CCB), University of Birmingham, Birmingham, UK
Arnaud Dechesne
Technical University of Denmark, Department of Environmental Engineering, bygning 115, Bygningstorvet, 2800 Kongens Lyngby, Denmark
Barth F. Smets
Technical University of Denmark, Department of Environmental Engineering, bygning 115, Bygningstorvet, 2800 Kongens Lyngby, Denmark
Jesús L. Romalde
Department of Microbiology and Parasitology, CIBUS-Faculty of Biology, Universidade de Santiago de Compostela, Santiago de Compostela 15782, Spain; CRETUS, Universidade de Santiago de Compostela, Santiago de Compostela 15782, Spain
Alberto Lema
Department of Microbiology and Parasitology, CIBUS-Faculty of Biology, Universidade de Santiago de Compostela, Santiago de Compostela 15782, Spain
Sabela Balboa
CRETUS, Universidade de Santiago de Compostela, Santiago de Compostela 15782, Spain
Carlos García-Riestra
Department of Microbiology and Parasitology, University Hospital Complex of Santiago (CHUS), Spain
Eva Torres-Sangiao
Escherichia coli Group, Research Foundation Institute (FIDIS), University Hospital Complex (CHUS), Santiago de Compostela, ES, Spain
Ami Neuberger
Infectious Diseases Institute, Rambam Health Care Campus, HaAliya HaShniya St 8, Haifa 3109601, Israel; The Ruth and Bruce Rappaport Faculty of Medicine, Technion – Israel Institute of Technology, Efron St 1, Haifa 3109601, Israel
David Graham
School of Engineering, Newcastle University, Newcastle upon Tyne, UK
Marcos Quintela-Baluja
School of Engineering, Newcastle University, Newcastle upon Tyne, UK
Dov J. Stekel
School of Biosciences, University of Nottingham, Sutton Bonington Campus, College Road, Loughborough LE12 5RD, UK
Jay Graham
University of California, Berkeley School of Public Health, Berkeley, CA, USA
Amy Pruden
The Charles Edward Via, Jr. Department of Civil and Environmental Engineering, Virginia Tech, Blacksburg, VA, USA
Joseph Nesme
Section of Microbiology, Department of Biology, Faculty of Science, University of Copenhagen, 2100 Copenhagen, Denmark
Søren Johannes Sørensen
Section of Microbiology, Department of Biology, Faculty of Science, University of Copenhagen, 2100 Copenhagen, Denmark
Rupert Hough
Information and Computational Sciences, The James Hutton Institute, Aberdeen AB15 8QH, Scotland, UK
Mical Paul
Infectious Diseases Institute, Rambam Health Care Campus, HaAliya HaShniya St 8, Haifa 3109601, Israel; The Ruth and Bruce Rappaport Faculty of Medicine, Technion – Israel Institute of Technology, Efron St 1, Haifa 3109601, Israel
Background: A One Health approach requires integrative research to elucidate antimicrobial resistance (AMR) in the environment and the risks it poses to human health. Research on this topic involves experts from diverse backgrounds and professions. Shortcomings exist in terms of consistent, complete, and transparent reporting in many environmental studies. Standardized reporting will improve the quality of scientific papers, enable meta-analyses and enhance the communication among different experts. In this study, we aimed to generate a consensus of reporting standards for AMR research in wastewater and related aquatic environments. Methods: Based on a risk of bias assessment of the literature in a systematic review, we proposed a set of study quality indicators. We then used a multistep modified Delphi consensus to develop the EMBRACE-WATERS statement (rEporting antiMicroBial ResistAnCE in WATERS), a checklist of recommendations for reporting in studies of AMR in wastewater and related aquatic environments. Findings: Consensus was achieved among a multidisciplinary panel of twenty-one experts in three steps. The developed EMBRACE-WATERS statement incorporates 21 items. Each item contains essential elements of high-quality reporting and is followed by an explanation of their rationale and a reporting-example. The EMBRACE-WATERS statement is primarily intended to be used by investigators to ensure transparent and comprehensive reporting of their studies. It can also guide peer-reviewers and editors in evaluation of manuscripts on AMR in the aquatic environment. This statement is not intended to be used to guide investigators on the methodology of their research. Interpretation: We are hopeful that this statement will improve the reporting quality of future studies of AMR in wastewater and related aquatic environments. Its uptake would generate a common language to be used among researchers from different disciplines, thus advancing the One Health approach towards understanding AMR spread across aquatic environments. Similar initiatives are needed in other areas of One Health research.
