Antimicrobial resistance in southeast Asian water environments: A systematic review of current evidence and future research directions

Recommendations of Key Elements within an Integrated Monitoring Framework of Antimicrobial Resistance for Asian Countries

“…For targeted microbes, we propose Escherichia coli as a strong monitoring candidate. Due to the frequent detection of E. coli and antimicrobially resistant E. coli in various environmental matrices in Asian countries, − the WHO proposed extended-spectrum β-lactamase (ESBL)-producing E. coli as a primary indicator of AMR in the tricycle protocol. In addition, because E. coli is used as a fecal contamination indicator in aquatic environments, the presence of antimicrobially resistant E. coli indicates the spread of AMR from human and animal sources. − Moreover, E. coli is the most studied bacterial species and has a rich genomic database, enabling the origin of AMR to be tracked through whole genome sequencing and multilocus sequence typing (MLST). ,,, …”

“…However, for effective data collection and rapid implementation in Asian countries, an integrated AMR monitoring framework across environment matrices that is feasible to implement in resourcelimited LMICs is required. 5 Designing this monitoring framework requires clarity about (i) what to monitor (i.e., target parameters of monitoring, including drug classes and bacterial species), (ii) how to monitor (i.e., analytical methods), and (iii) where to monitor (i.e., locations and frequency). Here, we examine these requirements and provide suggestions for environmental surveillance of AMR within an Asian context (Table 1).…”

“…The agenda aims to establish an integrated AMR surveillance system across the human, animal, and environmental sectors. However, for effective data collection and rapid implementation in Asian countries, an integrated AMR monitoring framework across environment matrices that is feasible to implement in resource-limited LMICs is required . Designing this monitoring framework requires clarity about (i) what to monitor (i.e., target parameters of monitoring, including drug classes and bacterial species), (ii) how to monitor (i.e., analytical methods), and (iii) where to monitor (i.e., locations and frequency).…”