Category: Thoughts

The Lennart Sparell Prize

I am happy to announce that Cancer- och Allergifonden [the Cancer and Allergy Foundation] have awarded me with the first Lennart Sparell prize. The prize was instated in memory of the foundations founder – Lennart Sparell, who passed away last year – and is awarded to researchers (or other persons) who have thought outside-of-the-box or challenged the current paradigms. A particular emphasis is given to research on environmental pollutants that affect human health through food or environmental exposure.

Naturally, I am honored to be the recipient of this prize. The award was motivated by the research I have done on the role of ecological and evolutionary processes in the external environment in driving antibiotic resistance development, and how that can have consequences for human health. Particularly, I am happy that the research that I, Joakim Larsson, Erik Kristiansson and a few others on the role of environmental processes in the development of antibiotic resistance and the recruitment of novel resistance genes are given attention. This view, which perhaps do not challenge the paradigm but at the very least points to an alternative risk scenario, has often been neglected when environmental antibiotic resistance has been discussed.

The prize will be awarded on a ceremony on June 10 in Stockholm, but I would already now take the opportunity to thank everyone who has been involved in the research being recognized, particularly Joakim Larsson and Erik Kristiansson – this award is to a very very large extent to your merit.

A good journal editor

Since I have previously criticized the practice of uninviting reviewers before the proposed deadline, I just wanted to share a very positive experience on the same theme. Yesterday, I received a very thoughtful message, containing the lines: “(…) Unless you have started your review, I would like to un-invite you from this assignment. You are not late with your review, but I have enough reviews with which to make a decision. Please let me know if you still wish to complete the review. (…)”

This is how easy it is to do a reviewer happy. Had I, for example, read the paper but not finished the report, I would have had the chance to submit it. In this case, other things had come in between and I had not yet started reading the manuscript. Thus, I was happy to pass on this one.

Other journal editors, take note. This is how you avoid pissing off reviewers (and it’s really not that hard).

Reshaping this site

This spring I am on part time parental leave with my son, and I have taken the opportunity to reshape this web site a bit – after all its design has not been updated since I launched the site in 2010. With the new site, I want to extend the scope of the web page a bit, focusing more on the lab I am setting up at the University of Gothenburg and less on myself alone. This will be a bit by bit process, and as you will notice most of the content does not yet reflect this change (yet).

The fact that I am on part-time parental leave (actually more like “most-time”) means that I will be slower than usual at responding to e-mails until (at least) the beginning of June. It also (sadly) means that I will have to decline a lot of nice invitations and proposals, or at least move them into the future when possible.

Finally, here’s a few things that will happen this year regardless. In April (16th to 18th), I will be at ICOHAR in Utrecht, where I will give a talk in a session on the role of the environment in the spread of antimicrobial resistance. Then in June, I will attend ASM Microbe in San Fransisco (June 20-24), where I will co-chair a session on Environmental Resistomes together with Ashley Shade. In this session I will also give a talk on the effect of antibiotics on interactions in microbial communities. However, I will not attend EDAR-5 in Hong Kong this year – there simply wasn’t time to fit that into the agenda as well. (Also, I am trying to cut down on air travel which contributed to the decision not to go this year.)

Published paper: benchmarking resistance gene identification

Since F1000Research uses a somewhat different publication scheme than most journals, I still haven’t understood if this paper is formally published after peer review, but I start to assume it is. There have been very little changes since the last version, so hence I will be lazy and basically repost what I wrote in April when the first version (the “preprint”) was posted online. The paper (1) is the result of a workshop arranged by the JRC in Italy in 2017. It describes various challenges arising from the process of designing a benchmark strategy for bioinformatics pipelines in the identification of antimicrobial resistance genes in next generation sequencing data.

The paper discusses issues about the benchmarking datasets used, testing samples, evaluation criteria for the performance of different tools, and how the benchmarking dataset should be created and distributed. Specially, we address the following questions:

  • How should a benchmark strategy handle the current and expanding universe of NGS platforms?
  • What should be the quality profile (in terms of read length, error rate, etc.) of in silico reference materials?
  • Should different sets of reference materials be produced for each platform? In that case, how to ensure no bias is introduced in the process?
  • Should in silico reference material be composed of the output of real experiments, or simulated read sets? If a combination is used, what is the optimal ratio?
  • How is it possible to ensure that the simulated output has been simulated “correctly”?
  • For real experiment datasets, how to avoid the presence of sensitive information?
  • Regarding the quality metrics in the benchmark datasets (e.g. error rate, read quality), should these values be fixed for all datasets, or fall within specific ranges? How wide can/should these ranges be?
  • How should the benchmark manage the different mechanisms by which bacteria acquire resistance?
  • What is the set of resistance genes/mechanisms that need to be included in the benchmark? How should this set be agreed upon?
  • Should datasets representing different sample types (e.g. isolated clones, environmental samples) be included in the same benchmark?
  • Is a correct representation of different bacterial species (host genomes) important?
  • How can the “true” value of the samples, against which the pipelines will be evaluated, be guaranteed?
  • What is needed to demonstrate that the original sample has been correctly characterised, in case real experiments are used?
  • How should the target performance thresholds (e.g. specificity, sensitivity, accuracy) for the benchmark suite be set?
  • What is the impact of these performance thresholds on the required size of the sample set?
  • How can the benchmark stay relevant when new resistance mechanisms are regularly characterized?
  • How is the continued quality of the benchmark dataset ensured?
  • Who should generate the benchmark resource?
  • How can the benchmark resource be efficiently shared?

Of course, we have not answered all these questions, but I think we have come down to a decent description of the problems, which we see as an important foundation for solving these issues and implementing the benchmarking standard. Some of these issues were tackled in our review paper from last year on using metagenomics to study resistance genes in microbial communities (2). The paper also somewhat connects to the database curation paper we published in 2016 (3), although this time the strategies deal with the testing datasets rather than the actual databases. The paper is the first outcome of the workshop arranged by the JRC on “Next-generation sequencing technologies and antimicrobial resistance” held October 4-5 2017 in Ispra, Italy. You can find the paper here (it’s open access).

On another note, the new paper describing the UNITE database (4) has now got a formal issue assigned to it, as has the paper on tandem repeat barcoding in fungi published in Molecular Ecology Resources last year (5).

References and notes

  1. Angers-Loustau A, Petrillo M, Bengtsson-Palme J, Berendonk T, Blais B, Chan KG, Coque TM, Hammer P, Heß S, Kagkli DM, Krumbiegel C, Lanza VF, Madec J-Y, Naas T, O’Grady J, Paracchini V, Rossen JWA, Ruppé E, Vamathevan J, Venturi V, Van den Eede G: The challenges of designing a benchmark strategy for bioinformatics pipelines in the identification of antimicrobial resistance determinants using next generation sequencing technologies. F1000Research, 7, 459 (2018). doi: 10.12688/f1000research.14509.1
  2. Bengtsson-Palme J, Larsson DGJ, Kristiansson E: Using metagenomics to investigate human and environmental resistomes. Journal of Antimicrobial Chemotherapy, 72, 2690–2703 (2017). doi: 10.1093/jac/dkx199
  3. Bengtsson-Palme J, Boulund F, Edström R, Feizi A, Johnning A, Jonsson VA, Karlsson FH, Pal C, Pereira MB, Rehammar A, Sánchez J, Sanli K, Thorell K: Strategies to improve usability and preserve accuracy in biological sequence databases. Proteomics, 16, 18, 2454–2460 (2016). doi: 10.1002/pmic.201600034
  4. Nilsson RH, Larsson K-H, Taylor AFS, Bengtsson-Palme J, Jeppesen TS, Schigel D, Kennedy P, Picard K, Glöckner FO, Tedersoo L, Saar I, Kõljalg U, Abarenkov K: The UNITE database for molecular identification of fungi: handling dark taxa and parallel taxonomic classifications. Nucleic Acids Research, 47, D1, D259–D264 (2019). doi: 10.1093/nar/gky1022
  5. Wurzbacher C, Larsson E, Bengtsson-Palme J, Van den Wyngaert S, Svantesson S, Kristiansson E, Kagami M, Nilsson RH: Introducing ribosomal tandem repeat barcoding for fungi. Molecular Ecology Resources, 19, 1, 118–127 (2019). doi: 10.1111/1755-0998.12944

Published paper: Diarrhea-causing bacteria in the Choqueyapu River in Bolivia

My first original paper of the year was just published in PLoS ONE. This is a collaboration with Åsa Sjöling’s group at the Karolinska Institute and the Universidad Mayor de San Andrés in Bolivia, and the project has been largely run by Jessica Guzman-Otazo.

Poor drinking water quality is a major cause of diarrhea, especially in the absence of well-working sewage treatment systems. In the study, we investigate the numbers of bacteria causing diarrhea (or actually, marker genes for those bacteria) in water, soil and vegetable samples from the Choqueyapu River area in La Paz – Bolivia’s third largest city (1). The river receives sewage and wastewater from industries and hospitals while flowing through La Paz. We found that levels of ETEC – a bacterium that causes severe diarrhea – were much higher in the city than upstream of it, including at a site where the river water is used for irrigation of crops.

In addition, several multi-resistant bacteria could be isolated from the samples, of which many were emerging, globally spreading, multi-resistant variants. The results of the study indicate that there is a real risk for spreading of diarrheal diseases by using the contaminated water for drinking and irrigation (2,3). Furthermore, the identification of multi-resistant bacteria that can cause human diseases show that water contamination is an important route through which antibiotic resistance can be transferred from the environment back to humans (4).

The study was published in PLoS ONE and can be found here.

References

  1. Guzman-Otazo J, Gonzales-Siles L, Poma V, Bengtsson-Palme J, Thorell K, Flach C-F, Iñiguez V, Sjöling Å: Diarrheal bacterial pathogens and multi-resistant enterobacteria in the Choqueyapu River in La Paz, Bolivia. PLoS ONE, 14, 1, e0210735 (2019). doi: 10.1371/journal.pone.0210735
  2. Graham DW, Collignon P, Davies J, Larsson DGJ, Snape J: Underappreciated Role of Regionally Poor Water Quality on Globally Increasing Antibiotic Resistance. Environ Sci Technol 141001154428000 (2014). doi: 10.1021/es504206x
  3. Bengtsson-Palme J: Antibiotic resistance in the food supply chain: Where can sequencing and metagenomics aid risk assessment? Current Opinion in Food Science, 14, 66–71 (2017). doi: 10.1016/j.cofs.2017.01.010
  4. Bengtsson-Palme J, Kristiansson E, Larsson DGJ: Environmental factors influencing the development and spread of antibiotic resistance. FEMS Microbiology Reviews, 42, 1, 68–80 (2018). doi: 10.1093/femsre/fux053

Updating the site backbone

Due to updates to PHP I have been forced into updating the backbone of this website (i.e. the WordPress installation). Since I have a few custom modifications to the site, there might be a few hours of unscheduled downtime over the next couple of weeks. I apologize for this (but the alternative would be to take the site down, which is not really a better option…) I hope you will have patience.

Mumame – Quantifying mutations in metagenomes

Let me get straight to something somewhat besides the point here: summer students can achieve amazing things! One such student I had the pleasure to work with this summer is Shruthi Magesh, and a preprint based on work she did with me at the Wisconsin Institute for Discovery this summer just got published on bioRxiv (1). The preprint describes a software tool called Mumame, which uses database information on mutations in DNA or protein sequences to search metagenomic datasets and quantifies the relative proportion of resistance mutations over wild type sequences.

In the preprint (1), we first of all show that Mumame works on amplicon data where we already knew the true outcome (2). Second, we show that we can detect differences in mutation frequencies in controlled experiments (2,3). Lastly, we use the tool to gain some further information about resistance patterns in sediments from polluted environments in India (4,5). Together these analyses show that one of the most central aspects for Mumame to be able to find mutations is having a very high number of sequenced reads in all libraries (preferably more than 50 million per library), because these mutations are generally rare – even in polluted environments and microcosms exposed to antibiotics. We expect Mumame to be a useful addition to metagenomic studies of e.g. antibiotic resistance, and to increase the detail by which metagenomes can be screened for phenotypically important differences.

While I did write the code for the software (with a lot of input from Viktor Jonsson, who also is a coauthor on the preprint, on the statistical analysis), Shruthi did the software testing and evaluations, and the paper would not have been possible hadn’t she wanted a bioinformatic summer project related to metagenomics, aside from her laboratory work. The resulting preprint is available from bioRxiv and the Mumame software is freely available from this site.

References

  1. Magesh S, Jonsson V, Bengtsson-Palme JQuantifying point-mutations in metagenomic data. bioRxiv, 438572 (2018). doi: 10.1101/438572 [Link]
  2. Kraupner N, Ebmeyer S, Bengtsson-Palme J, Fick J, Kristiansson E, Flach C-F, Larsson DGJ: Selective concentration for ciprofloxacin in Escherichia coli grown in complex aquatic bacterial biofilms. Environment International, 116, 255–268 (2018). doi: 10.1016/j.envint.2018.04.029 [Paper link]
  3. Lundström S, Östman M, Bengtsson-Palme J, Rutgersson C, Thoudal M, Sircar T, Blanck H, Eriksson KM, Tysklind M, Flach C-F, Larsson DGJ: Minimal selective concentrations of tetracycline in complex aquatic bacterial biofilms. Science of the Total Environment, 553, 587–595 (2016). doi: 10.1016/j.scitotenv.2016.02.103 [Paper link]
  4. Bengtsson-Palme J, Boulund F, Fick J, Kristiansson E, Larsson DGJ: Shotgun metagenomics reveals a wide array of antibiotic resistance genes and mobile elements in a polluted lake in India. Frontiers in Microbiology, 5, 648 (2014). doi: 10.3389/fmicb.2014.00648 [Paper link]
  5. Kristiansson E, Fick J, Janzon A, Grabic R, Rutgersson C, Weijdegård B, Söderström H, Larsson DGJ: Pyrosequencing of antibiotic-contaminated river sediments reveals high levels of resistance and gene transfer elements. PLoS ONE, Volume 6, e17038 (2011). doi:10.1371/journal.pone.0017038.

Published paper: The global topsoil microbiome

I’m really late at this ball for a number of reasons, but last week Nature published our paper on the structure and function of the global topsoil microbiome (1). This paper has a long story, but in short I got contacted by Mohammad Bahram (the first author) about two years ago about a project using metagenomic sequencing to look at a lot of soil samples for patterns of antibiotic resistance gene abundances and diversity. The project had made the interesting discovery that resistance gene abundances were linked to the ratio of fungi and bacteria (so that more fungi was linked to more resistance genes). During the following year, we together worked on deciphering these discoveries, which are now published in Nature. The paper also deals with the taxonomic patterns linked to geography (1), but as evident from the above, my main contribution here has been on the antibiotic resistance side.

In short, we find that:

  • Bacterial diversity is highest in temperate habitats, and lower both closer to the equator and the poles
  • For bacteria, the diversity of biological functions follows the same pattern, but for fungi, the functional diversity is higher closer to the poles and the equator
  • Higher abundance of fungi is linked to higher abundance and diversity of antibiotic resistance genes. Specifically, this is related to known antibiotic producing fungal lineages, such as Penicillium and Oidiodendron. There also seems to be a link between the Actinobacteria, encompassing the antibiotic-producing bacterial genus of Streptomyces and higher resistance gene diversity.
  • Similar relationships between the fungus-like Oomycetes and resistance genes was also found in ocean samples from the Tara Oceans project (2)

The results of this study indicate that both environmental filtering and niche differentiation determine soil microbial composition, and that the role of dispersal limitation is minor at this scale. Soil pH and precipitation seems to be the strongest drivers of community composition. Furthermore, we interpret our data to reveal that inter-kingdom antagonism is important in structuring microbial communities. This speaks against the notion put forward that antibiotic resistance genes might not have a resistance function in natural settings (3). That said, the most likely explanation here is probably a bit of both warfare and repurposing of genes. Soil seems to be the largest untapped source of resistance genes for human pathogens (4), and the finding that natural antagonism may be driving resistance gene diversification and enrichment may be important for future management of environmental antibiotic resistance (5,6).

It was really great to work with Mohammad and his team, and I sure hope that we will collaborate again in the future. The entire paper can be found in the issue of Nature coming out this week, and is already online at Nature’s website.

References

  1. Bahram M°, Hildebrand F°, Forslund SK, Anderson JL, Soudzilovskaia NA, Bodegom PM, Bengtsson-Palme J, Anslan S, Coelho LP, Harend H, Huerta-Cepas J, Medema MH, Maltz MR, Mundra S, Olsson PA, Pent M, Põlme S, Sunagawa S, Ryberg M, Tedersoo L, Bork P: Structure and function of the global topsoil microbiome. Nature, 560, 233–237 (2018). doi: 10.1038/s41586-018-0386-6
  2. Sunagawa S et al. Structure and function of the global ocean microbiome. Science 348, 6237, 1261359 (2015). doi: 10.1126/science.1261359
  3. Aminov RI: The role of antibiotics and antibiotic resistance in nature. Environmental Microbiology, 11, 12, 2970-2988 (2009). doi: 10.1111/j.1462-2920.2009.01972.x
  4. Bengtsson-Palme J: The diversity of uncharacterized antibiotic resistance genes can be predicted from known gene variants – but not always. Microbiome, 6, 125 (2018). doi: 10.1186/s40168-018-0508-2
  5. Bengtsson-Palme J, Kristiansson E, Larsson DGJ: Environmental factors influencing the development and spread of antibiotic resistance. FEMS Microbiology Reviews, 42, 1, 68–80 (2018). doi: 10.1093/femsre/fux053
  6. Larsson DGJ, Andremont A, Bengtsson-Palme J, Brandt KK, de Roda Husman AM, Fagerstedt P, Fick J, Flach C-F, Gaze WH, Kuroda M, Kvint K, Laxminarayan R, Manaia CM, Nielsen KM, Ploy M-C, Segovia C, Simonet P, Smalla K, Snape J, Topp E, van Hengel A, Verner-Jeffreys DW, Virta MPJ, Wellington EM, Wernersson A-S: Critical knowledge gaps and research needs related to the environmental dimensions of antibiotic resistance. Environment International, 117, 132–138 (2018).

Published paper: Predicting the uncharacterized resistome

Over the weekend, Microbiome put online my most recent paper (1) – a project which started as an idea I got when I finished up my PhD thesis in 2016. One of my main points in the thesis (2), which was also made again on our recent review on environmental factors influencing resistance development (3), is that the greatest risks associated with antibiotic resistance in the environment may not be the resistance genes already circulating in pathogens (which are relatively easily quantified), but the ones associated with recruitment of novel resistance genes from bacteria in the environment (2-4). The latter genes are, however, impossible to quantify due to the fact that they are unknown. But what if we could use knowledge of the diversity and abundance of known resistance genes to estimate the same properties of the yet uncharacterized resistome? That would be a great advantage in e.g. ranking of risk environments, as then some property that is easily monitored can be used to inform risk management of both known and unknown resistance factors.

This just published paper explores this possibility, by quantifying the abundance and diversity of resistance genes in 1109 metagenomes from various environments (1). I have taken two different approaches. First, I took out smaller subsets of genes from the reference database (in this case Resqu, a database of antibiotic resistance genes with verified resistance functions, detected on mobile genetic elements), and used those subsets to estimate resistome diversity and abundance in the 1109 metagenomes. Then these predictions were compared to the results of the entire database. I then, in a second step, investigated if these predictions could be extended to a set of truly novel resistance genes, i.e. the resistance genes present in the FARME database, collecting data from functional metagenomics inserts (5,6).

The results show that generally the diversity and abundance of known antibiotic resistance genes can be used to predict the same properties of undescribed resistance genes (see figure above). However, the extent of this predictability is, importantly, dependent on the type of environment investigated. The study also shows that carefully selected small sets of resistance genes can describe total resistance gene diversity remarkably well. This means that knowledge gained from large-scale quantifications of known resistance genes can be utilized as a proxy for unknown resistance factors. This is important for current and proposed monitoring efforts for environmental antibiotic resistance (7-11) and has implications for the design of risk ranking strategies and the choices of measures and methods for describing resistance gene abundance and diversity in the environment.

The study also investigated which diversity measures were best suited to estimate total diversity. Surprisingly, some diversity measures described the total diversity of resistance genes remarkably bad. Most prominently, the Simpson diversity index consistently showed poor performance, and while the Shannon index performed relatively better, there is still no reason to select the Shannon index over normalized (rarefied) richness of resistance genes. The ACE estimator fluctuated substantially compared to the other diversity measures, while the Chao1 estimator more consistently showed performance very similar to richness. Therefore, either richness or the Chao1 estimator should be used for ranking resistance gene diversity, while the Shannon, Simpson, and ACE measures should be avoided.

Importantly, this study implies that the recruitment of novel antibiotic resistance genes from the environment to human pathogens is essentially random. Therefore, when ranking risks associated with antibiotic resistance in environmental settings, the knowledge gained from large-scale quantification of known resistance genes can be utilized as a proxy for the unknown resistance factors (although this proxy is not perfect). Thus, high-risk environments for resistance development and dissemination would, for example, be aquaculture, animal husbandry, discharges from antibiotic manufacturing, and untreated sewage (3,8,12-15). Further attention should probably be paid to antibiotic contaminated soils, as this study points to soils as a vast source of resistance genes not yet encountered in human pathogens. This has also been suggested previously by others (16-19). The results of this study can be used to guide monitoring efforts for environmental antibiotic resistance, to design risk ranking strategies, and to choose appropriate measures and methods for describing resistance gene abundance and diversity in the environment. The entire open access paper is available here.

References

  1. Bengtsson-Palme J: The diversity of uncharacterized antibiotic resistance genes can be predicted from known gene variants – but not always. Microbiome, 6, 125 (2018). doi: 10.1186/s40168-018-0508-2
  2. Bengtsson-Palme J: Antibiotic resistance in the environment: a contribution from metagenomic studies. Doctoral thesis (medicine), Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, 2016. [Link]
  3. Bengtsson-Palme J, Kristiansson E, Larsson DGJ: Environmental factors influencing the development and spread of antibiotic resistance. FEMS Microbiology Reviews, 42, 1, 68–80 (2018). doi: 10.1093/femsre/fux053
  4. Bengtsson-Palme J, Larsson DGJ: Antibiotic resistance genes in the environment: prioritizing risks. Nature Reviews Microbiology, 13, 369 (2015). doi: 10.1038/nrmicro3399-c1
  5. Wallace JC, Port JA, Smith MN, Faustian EM: FARME DB: a functional antibiotic resistance element database. Database, 2017, baw165 (2017).
  6. Handelsman J, Rondon MR, Brady SF, Clardy J, Goodman RM: Molecular biological access to the chemistry of unknown soil microbes: a new frontier for natural products. Chemical Biology, 5, R245–249 (1998).
  7. Berendonk TU, Manaia CM, Merlin C, Fatta-Kassinos D, Cytryn E, Walsh F, et al.: Tackling antibiotic resistance: the environmental framework. Nature Reviews Microbiology, 13, 310–317 (2015).
  8. Pruden A, Larsson DGJ, Amézquita A, Collignon P, Brandt KK, Graham DW, et al.: Management options for reducing the release of antibiotics and antibiotic resistance genes to the environment. Environmental Health Perspectives, 121, 878–885 (2013).
  9. Review on Antimicrobial Resistance: Antimicrobials in agriculture and the environment: reducing unnecessary use and waste. O’Neill J, ed. London: Wellcome Trust & HM Government (2015).
  10. Angers-Loustau A, Petrillo M, Bengtsson-Palme J, Berendonk T, Blais B, Chan KG, Coque TM, Hammer P, Heß S, Kagkli DM, Krumbiegel C, Lanza VF, Madec J-Y, Naas T, O’Grady J, Paracchini V, Rossen JWA, Ruppé E, Vamathevan J, Venturi V, Van den Eede G: The challenges of designing a benchmark strategy for bioinformatics pipelines in the identification of antimicrobial resistance determinants using next generation sequencing technologies. F1000Research, 7, 459 (2018). doi: 10.12688/f1000research.14509.1
  11. Larsson DGJ, Andremont A, Bengtsson-Palme J, Brandt KK, de Roda Husman AM, Fagerstedt P, Fick J, Flach C-F, Gaze WH, Kuroda M, Kvint K, Laxminarayan R, Manaia CM, Nielsen KM, Ploy M-C, Segovia C, Simonet P, Smalla K, Snape J, Topp E, van Hengel A, Verner-Jeffreys DW, Virta MPJ, Wellington EM, Wernersson A-S: Critical knowledge gaps and research needs related to the environmental dimensions of antibiotic resistance. Environment International, 117, 132–138 (2018). doi: 10.1016/j.envint.2018.04.041
  12. Allen HK, Donato J, Wang HH, Cloud-Hansen KA, Davies J, Handelsman J: Call of the wild: antibiotic resistance genes in natural environments. Nature Reviews Microbiology, 8, 251–259 (2010).
  13. Graham DW, Collignon P, Davies J, Larsson DGJ, Snape J: Underappreciated role of regionally poor water quality on globally increasing antibiotic resistance. Environmental Science & Technology, 48,11746–11747 (2014).
  14. Larsson DGJ: Pollution from drug manufacturing: review and perspectives. Philosophical Transactions of the Royal Society of London, Series B Biological Sciences, 369, 20130571 (2014).
  15. Cabello FC, Godfrey HP, Buschmann AH, Dölz HJ: Aquaculture as yet another environmental gateway to the development and globalisation of antimicrobial resistance. Lancet Infectious Diseases, 16, e127–133 (2016).
  16. Forsberg KJ, Reyes A, Wang B, Selleck EM, Sommer MOA, Dantas G: The shared antibiotic resistome of soil bacteria and human pathogens. Science, 337, 1107–1111 (2012).
  17. Allen HK, Moe LA, Rodbumrer J, Gaarder A, Handelsman J: Functional metagenomics reveals diverse beta-lactamases in a remote Alaskan soil. ISME Journal, 3, 243–251 (2009).
  18. Riesenfeld CS, Goodman RM, Handelsman J: Uncultured soil bacteria are a reservoir of new antibiotic resistance genes. Environmental Microbiology, 6, 981–989 (2004).
  19. McGarvey KM, Queitsch K, Fields S: Wide variation in antibiotic resistance proteins identified by functional metagenomic screening of a soil DNA library. Applied and Environmental Microbiology, 78, 1708–1714 (2012).