Atmospheric detection, prevalence, transmission, health and ecological consequences of antibiotic resistance genes and resistant bacteria: A comprehensive review

Globally atmospheric transmission of antibiotic-resistance genes (ARGs) and antibiotic-resistant bacteria (ARB) poses a serious challenge to human health and the environment. Thus, a comprehensive and systematic review was established to focus on the detection and analytical methods, distribution characteristics, transmission mechanisms, potential impact on human health and ecological environment of ARGs and ARB in the atmosphere. Emerging methods, such as machine learning and deep learning in artificial intelligence, as well as isothermal amplification methods, have considerably improved the detection efficiency of ARGs and ARB in the atmosphere, along with conventional methods such as Polymerase chain reaction (PCR), PCR derivative methods, and metagenomic sequencing. ARGs and ARB are widely detected in various atmospheric environment, significantly in hospitals, pharmaceutical factories, animal farms, wastewater treatment plants, municipal solid waste landfills and densely populated indoor environments. They can be transferred over extensive distances in the atmosphere via bioaerosols, with their distribution and survival markedly affected by meteorological and climatic factors as well as air contaminants. The transmissions of ARGs and ARB may alter microbial community structures, impact biodiversity, and enhance human exposure risks via inhalation, skin contact, and ingestion. This review synthesizes ARGs and ARB in the atmosphere and provides scientific evidence for policy development and further research, which should focus on the development of intelligent and accurate detection methods, construction of cross-media transmission mechanism and global model, establishment of global health risk assessment system to face the global challenge of antimicrobial resistance.