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In total, 239 datasets adhered to inclusion criteria. AMR bacteria were detected at exposure-relevant sites (35\/38), including recreational areas, drinking water, ambient air, and shellfish, and in fresh produce (8\/16). More datasets were available for environmental compartments (139\/157), including wildlife, water, soil, and air\/dust. Quantitative data from exposure-relevant sites (6\/35) and environmental compartments (11\/139) were scarce. AMR bacteria were detected in the contamination sources (66\/66) wastewater and manure, and molecular data supporting their transmission from wastewater to the environment (1\/66) were found. The abundance of AMR bacteria at exposure-relevant sites suggests risk for human exposure. Of publications pertaining to both environmental and human isolates, however, only one compared isolates from samples that had a clear spatial and temporal relationship, and no direct evidence was found for transmission to humans through the environment. To what extent the environment, compared to the clinical and veterinary domains, contributes to human exposure needs to be quantified. AMR bacteria in the environment, including sites relevant for human exposure, originate from contamination sources. Intervention strategies targeted at these sources could therefore limit emission of AMR bacteria to the environment.<\/jats:p>","DOI":"10.1021\/acs.est.5b02566","type":"journal-article","created":{"date-parts":[[2015,9,10]],"date-time":"2015-09-10T16:32:37Z","timestamp":1441902757000},"page":"11993-12004","source":"Crossref","is-referenced-by-count":395,"title":["Role\nof the Environment in the Transmission of Antimicrobial\nResistance to Humans: A Review"],"prefix":"10.1021","volume":"49","author":[{"given":"Patricia\nM. C.","family":"Huijbers","sequence":"first","affiliation":[{"name":"Wageningen University , , P.O. Box 338, 6700 AH Wageningen ,","place":["The Netherlands"]},{"name":"National Institute for Public Health and the Environment (RIVM) , , P.O. Box 1, 3720 BA Bilthoven ,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hetty","family":"Blaak","sequence":"additional","affiliation":[{"name":"National Institute for Public Health and the Environment (RIVM) , , P.O. Box 1, 3720 BA Bilthoven ,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mart C. M.","family":"de Jong","sequence":"additional","affiliation":[{"name":"Wageningen University , , P.O. Box 338, 6700 AH Wageningen ,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elisabeth A. M.","family":"Graat","sequence":"additional","affiliation":[{"name":"Wageningen University , , P.O. Box 338, 6700 AH Wageningen ,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christina M. J. E.","family":"Vandenbroucke-Grauls","sequence":"additional","affiliation":[{"name":"VU University Medical Center , , P.O. Box 7057, 1007 MB Amsterdam ,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana Maria","family":"de Roda Husman","sequence":"additional","affiliation":[{"name":"National Institute for Public Health and the Environment (RIVM) , , P.O. Box 1, 3720 BA Bilthoven ,","place":["The Netherlands"]},{"name":"Utrecht University , , P.O. Box 80178, 3508 TD Utrecht ,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"316","published-online":{"date-parts":[[2015,9,10]]},"reference":[{"key":"2026081501110807500_cit1","unstructured":"World Health Organization\n(WHO)\n          . 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Infect."},{"key":"2026081501110807500_cit50","doi-asserted-by":"publisher","first-page":"4340","DOI":"10.3390\/ijerph110404340","article-title":"Occupational\nexposure to Staphylococcus aureus and Enterococcus spp. among spray irrigation worker using reclaimed water","volume":"11","author":"Rosenberg\nGoldstein","year":"2014","journal-title":"Int. J. Environ. Res. Public Health"},{"key":"2026081501110807500_cit51","doi-asserted-by":"publisher","first-page":"2643","DOI":"10.1021\/es404988k","article-title":"Effect of\nmanure application on abundance of antibiotic resistance genes and\ntheir attenuation rates in soil: Field-scale mass balance approach","volume":"48","author":"Fahrenfeld","year":"2014","journal-title":"Environ. Sci. Technol."},{"key":"2026081501110807500_cit52","doi-asserted-by":"publisher","first-page":"1086","DOI":"10.2134\/jeq2008.0128","article-title":"Fate and transport\nof antibiotic residues and antibiotic resistance genes following land\napplication of manure waste","volume":"38","author":"Chee-Sanford","year":"2009","journal-title":"J. Environ. Qual."},{"key":"2026081501110807500_cit53","doi-asserted-by":"publisher","first-page":"878","DOI":"10.1289\/ehp.1206446","article-title":"Management options for reducing the\nrelease of antibiotics and antibiotic resistance genes to the environment","volume":"121","author":"Pruden","year":"2013","journal-title":"Environ. Health. Perspect."},{"key":"2026081501110807500_cit54","first-page":"319","article-title":"Membrane-supported\nbiological wastewater treatment","volume":"105","author":"Kru\u0308ger","year":"2000","journal-title":"Schriftenr.\nVer. Wasser. 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