Risk assessmentindependent cross-checkabstract checked★ key study I-CHK-115 in-depth review
Most resistant gut bacteria in Dutch people come from other people, about one fifth from food
Attributable sources of community-acquired carriage of Escherichia coli containing beta-lactam antibiotic resistance genes: a population-based modelling study.
Overview
Mughini-Gras L et al.. Lancet Planet Health 2019 · PMID 31439317 · DOI 10.1016/S2542-5196(19)30130-5
Food accounted for about 19% of community carriage of ESBL E. coli; human-to-human spread for about 60%.
Does the study support the specific claim? Partly · Methodological quality: moderate
Plain-language summary
Study explained simply
- What did the researchers want to find out?
What proportion of community-acquired ESBL/pAmpC E. coli carriage is attributable to human, animal, food and environmental sources?
- How was the study done?
Population-based source-attribution modelling (ESBL/pAmpC genes), Netherlands 2005-2017
- How many people, animals or samples were studied?
1,220 human and 6,275 non-human gene occurrences
- What was actually found?
Human-to-human transmission within/between households 60.1% (95% CrI 40.0-73.5); secondary transmission from high-risk groups 6.9%; food 18.9% (7.0-38.3); companion animals 7.9%; farm animals (non-occupational) 3.6%; environment 2.6%. R0 for intracommunity transmission 0.63.
- How large was the observed effect?
Human-to-human transmission within/between households 60.1% (95% CrI 40.0-73.5); secondary transmission from high-risk groups 6.9%; food 18.9% (7.0-38.3); companion animals 7.9%; farm animals (non-occupational) 3.6%; environment 2.6%. R0 for intracommunity transmission 0.63.
- What do the results mean in everyday life?
Food is a real but not the main route for these resistant bacteria in the Netherlands.
- What are the study's limitations?
Model assumptions; Food not split by type in abstract; Erratum published
- What does it say about Elawady's specific claim?
Supports the food-chain route but limits its size.
- Do the results apply to Germany and Europe?
Directly EU-relevant (Netherlands).
- What can explicitly not be concluded from this study?
Not specific to chicken; different in high-use countries.
Scientific in-depth review
1. Full reference
- Authors
- Mughini-Gras L et al.
- Journal
- Lancet Planet Health
- Year
- 2019
- Identifier
- PMID 31439317 DOI 10.1016/S2542-5196(19)30130-5
- Verification
- verified – PubMed efetch 2026-10-26; Crossref 2026-10-26
- Retracted
- no
- Corrections
ErratumIn: Lancet Planet Health 2019;3(10):e408
- Extent checked
- abstract only
- Conflicts of interest and funding
1Health4Food, Dutch Ministry of Economic Affairs, EU Horizon 2020 One Health EJP (abstract)
2. Research question
What proportion of community-acquired ESBL/pAmpC E. coli carriage is attributable to human, animal, food and environmental sources?
3. Study design and population
- Study design
- Risk assessment – Population-based source-attribution modelling (ESBL/pAmpC genes), Netherlands 2005-2017
- Population
Dutch population; gene data from humans, animals, food, water, wild birds
- Country
Netherlands
- Period
2005-2017
- Sample size
1,220 human and 6,275 non-human gene occurrences
- Inclusion and exclusion criteria
as described in the abstract
4. Methods and endpoints
- Exposure / intervention
Exposure to sources (food, animals, environment, other humans)
- Comparator
Other sources
- Endpoints
Attributable share of community carriage
- Statistical methods
as reported in the abstract
5. Actual results
- Results
Human-to-human transmission within/between households 60.1% (95% CrI 40.0-73.5); secondary transmission from high-risk groups 6.9%; food 18.9% (7.0-38.3); companion animals 7.9%; farm animals (non-occupational) 3.6%; environment 2.6%. R0 for intracommunity transmission 0.63.
- Absolute risks
not reported
- Authors' conclusion
Humans are the main source of community carriage, but non-human sources are needed to sustain spread.
6. Strengths
- Large national dataset
- Explicit uncertainty
7. Weaknesses
- Model assumptions
- Food not split by type in abstract
- Erratum published
8. Risk of bias
- Orienting tool
- none applicable
- Type of assessment
- simplified assessment (abstract only)
- Full formal assessment
- no
- Overall risk of bias
- some concerns
- Rationale
Modelling study.
9. Assessment of the statistical interpretation
Food (including chicken) contributes about one fifth of carriage, with wide uncertainty; most carriage is spread between people.
10. Relevance to the specific claim
Quantifies how much resistant E. coli carriage comes from food versus other sources.
11. Independent contrary findings
12. Transferability to Germany and Europe
13. Overall methodological judgement
Food accounted for about 19% of community carriage of ESBL E. coli; human-to-human spread for about 60%.
| Multidimensional assessment | |
|---|---|
| Authenticity of the source | verified |
| Methodological quality | moderate |
| Risk of bias | some concerns |
| Precision of results | low |
| Directness | direct |
| Reproducibility | partly replicated |
| Consistency with the overall evidence | consistent |
| Regional transferability | moderate |
| Adequacy of the interpretation (by the archive) | not applicable |