ArticleThe Lancet. Microbe2023
Evaluating the relationship between community water and sanitation access and the global burden of antibiotic resistance: an ecological study.
Article in The Lancet. Microbe, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 46 papers, 1 of them a synthesis that pooled it.
What it found
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The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
46 citing papers in PubMed, 1 synthesis or guideline pooled it, 68 citations in OpenAlex.
- Antimicrobial resistance in community-acquired enteric pathogens among children aged ≤ 10-years in low-and middle-income countries: a systematic review and meta-analysis.Frontiers in microbiology · 2025Pooled it
- Water, sanitation, handwashing, and nutritional interventions can reduce child antibiotic use: evidence from Bangladesh and Kenya.Nature communications · 2025Trial
- Genomic epidemiology of extended-spectrum beta-lactamase-producingJAC-antimicrobial resistance · 2026Article
- Antimicrobial Resistance Under a Changing Climate.Journal of the Royal Society of New Zealand · 2026Article
- Antimicrobial-resistantmedRxiv : the preprint server for health sciences · 2026Article
- Review
- Travel-Induced Circadian and Microbiota Disturbances: Implications for Athlete Health and Performance: A Narrative Review.Nutrients · 2026Review
- Animal husbandry and environmental conditions are associated with cefotaxime-resistantmedRxiv : the preprint server for health sciences · 2026Article
- Article
- Biosynthesis gene cluster-containing species drive microbial community stability under thermal stress through enhanced ecological cohesion.iMetaOmics · 2026Article
- Evaluating Antibiotic Resistance in Urban Rivers and Coral Reefs of Belize: Evidence for Hotspots and a Potential Screening Tool.GeoHealth · 2026Article
- Sociodemographic and Health Factors Are Associated with Antimicrobial Resistance across Eight States in the United States.Environmental science & technology · 2026Article
- Animal husbandry and environmental conditions are associated with cefotaxime-resistant Escherichia coli in yard soil in peri-urban Malawi.PLOS global public health · 2026Article
- Environmental exposures associated with the gut microbiome and resistome of pregnant women and children in Northwest Ecuador.Nature communications · 2025Article
- Effects of commonly used antibiotics on children's developing gut microbiomes and resistomes in peri-urban Lima, Peru.The Journal of antimicrobial chemotherapy · 2025Article
- Role of the gut microbiome in frequent gut colonization with extended-spectrum β lactamase-producing Enterobacterales among Peruvian children.Gut microbes · 2025Article
- Leveraging a people-centred approach to combat antimicrobial resistance in Africa.Tropical medicine and health · 2025Review
- Exploring the association between multi-dimensional poverty and antibiotic resistance: findings from a mixed-methods study in Pakistan.The Lancet regional health. Southeast Asia · 2025Article
- Strategies and Recent Advances in Tackling Antibacterial Resistance in India: A Comprehensive Narrative Review.Cureus · 2025Review
- Context-Seq: CRISPR-Cas9 targeted nanopore sequencing for transmission dynamics of antimicrobial resistance.Nature communications · 2025Article
Corrections and comments
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Authors and funding
18 authors at 14 institutions in 7 countries.
Funding
Abstract
backgroundAntibiotic resistance is a leading cause of death, with the highest burden occurring in low-resource settings. There is little evidence on the potential for water, sanitation, and hygiene (WASH) access to reduce antibiotic resistance in humans. We aimed to determine the relationship between the burden of antibiotic resistance in humans and community access to drinking water and sanitation.
methodsIn this ecological study, we linked publicly available, geospatially tagged human faecal metagenomes (from the US National Center for Biotechnology Information Sequence Read Archive) with georeferenced household survey datasets that reported access to drinking water sources and sanitation facility types. We used generalised linear models with robust SEs to estimate the relationship between the abundance of antibiotic resistance genes (ARGs) in human faecal metagenomes and community-level coverage of improved drinking water and sanitation within a defined radii of faecal metagenome coordinates.
findingsWe identified 1589 metagenomes from 26 countries. The mean abundance of ARGs, in units of log
interpretationAlthough additional studies to investigate causal effects are needed, increasing access to water and sanitation could be an effective strategy to curb the proliferation of antibiotic resistance in low-income and middle-income countries.
fundingBill & Melinda Gates Foundation.
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What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.