OHEJP-RaDAR-D-JRP3-2.4 Report on intervention strategies

Title 1: Report on intervention strategies

The first step of this project was to quantify the relative importance of AMR transmission pathways. For this we have performed a review of the literarure 1),  resulting in 6054 articles published up until January 1st, 2019. Full text screening was performed on 525 articles and 277 are included. This review took considerably more time than anticipated given the huge number of papers that had to be screened. The main conclusion of the review is that, on the one hand, there is a plethora of estimates and studies on risk factors and transmission routes of ABR bacteria, while on the other hand, the relevance of routes on a population scale is missing. As the frequency at which all kind of risk factors and exposure occurs, the relevance of transmission routes on a population level are lacking. For a specific pathogen, i.e.,  Escherichia coli containing β-lactam antibiotic resistance genes, we importance could be obtained 2), but even this study could pinpoint (with some uncertainty) how important different reservoirs are for the acquisition by humans of Escherichia coli containing β-lactam antibiotic resistance genes, but could not pinpoint the mechanisms behind the transmission routes. Given the almost complete absence of estimates of the importance of AMR transmission pathways, a mathematical model to calculate reproduction numbers would be highly speculative and any assessment of the effectiveness of intervention measures would lead to high-levels of uncertainty.