Impacts of Antibiotic Residues in the Environment on Bacterial Resistance and Human Health in Eastern China: An Interdisciplinary Mixed-Methods Study Protocol

Shenghan Cai, Na Wang, Like Xu, Fei Yan, Qingwu Jiang, Xinping Zhao, Wei Wang, Hexing Wang, Lufang Jiang, Wenjuan Cong, Samuel K. Sheppard, Jason Weeks, Barbara Kasprzyk-Hordern, Chaowei Fu, Helen Lambert

Research output: Contribution to journalArticlepeer-review

6 Citations (SciVal)


Antibiotic resistance is a global health challenge that threatens human and animal lives, especially among low-income and vulnerable populations in less-developed countries. Its multi-factorial nature requires integrated studies on antibiotics and resistant bacteria in humans, animals, and the environment. To achieve a comprehensive understanding of the situation and management of antibiotic use and environmental transmission, this paper describes a study protocol to document human exposure to antibiotics from major direct and indirect sources, and its potential health outcomes. Our mixed-methods approach addresses both microbiological and pathogen genomics, and epidemiological, geospatial, anthropological, and sociological aspects. Implemented in two rural residential areas in two provinces in Eastern China, linked sub-studies assess antibiotic exposure in population cohorts through household surveys, medicine diaries, and biological sampling; identify the types and frequencies of antibiotic resistance genes in humans and food-stock animals; quantify the presence of antibiotic residues and antibiotic resistance genes in the aquatic environment, including wastewater; investigate the drivers and behaviours associated with human and livestock antibiotic use; and analyse the national and local policy context, to propose strategies and systematic measurements for optimising and monitoring antibiotic use. As a multidisciplinary collaboration between institutions in the UK and China, this study will provide an in-depth understanding of the influencing factors and allow comprehensive awareness of the complexity of AMR and antibiotic use in rural Eastern China.

Original languageEnglish
Article number8145
JournalInternational Journal of Environmental Research and Public Health
Issue number13
Publication statusPublished - 1 Jul 2022


  • antibiotic exposure
  • antibiotic resistance
  • antibiotic-resistant bacteria
  • cohort study
  • mixed methods
  • transmission
  • wastewater-based epidemiology

ASJC Scopus subject areas

  • Pollution
  • Public Health, Environmental and Occupational Health
  • Health, Toxicology and Mutagenesis


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