Systematic review in South Africa reveals antibiotic resistance genes shared between clinical and environmental settings Mutshiene Deogratias Ekwanzala,1 John Barr Dewar,2 Ilunga Kamika,3 Maggy Ndombo Benteke Momba1 1Department of Environmental, Water and Earth Sciences, Tshwane University of Technology, Pretoria, South Africa; 2Department of Life and Consumer Sciences, University of South Africa, Johannesburg, South Africa; 3Department of Environmental Sciences, University of South Africa, Johannesburg, South Africa Abstract: A systematic review was conducted to determine the distribution and prevalence of antibiotic-resistant bacteria (ARB), antimicrobial-resistant genes (ARGs), and antimicrobial-resistant gene determinants (ARGDs) in clinical, environmental, and farm settings and to identify key knowledge gaps in a bid to contain their spread. Fifty-three articles were included. The prevalence of a wide range of antimicrobial-resistant bacteria and their genes was reviewed. Based on the studies reviewed in this systematic review, mutation was found to be the main genetic element investigated. All settings shared 39 ARGs and ARGDs. Despite the fact that ARGs found in clinical settings are present in the environment, in reviewed articles only 12 were found to be shared between environmental and clinical settings; the inclusion of farm settings with these two settings increased this figure to 32. Data extracted from this review revealed farm settings to be one of the main contributors of antibiotic resistance in healthcare settings. ARB, ARGs, and ARGDs were found to be ubiquitous in all settings examined. Keywords: systematic review, ARB, clinical ARGs, environmental ARGs, ARGDs, South Africa