Seizing the moment: now is the time for integrated global surveillance of antimicrobial resistance in wastewater environments

Pruden, Amy; Vikesland, Peter J.; Davis, Benjamin C.; Husman, Ana Maria de Roda

doi:10.1016/j.mib.2021.09.013

Cited by 77 publications

(54 citation statements)

References 48 publications

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“…Coordinated environmental surveillance efforts employing standard methods, ideally at local, regional, national, and global scales, will be required to address these questions and to inform corresponding policy and practice to stem the spread of AMR. 36 …”

Section: Critical Research Needs Call For Standardized Methods For Am...mentioning

confidence: 99%

“…This suggests that recent momentum in monitoring sewage for SARS-CoV-2 could spur adoption of monitoring of AMR-relevant targets and open the door to broader AMR monitoring to meet other objectives as well. 36 For example, “quantifying removal of AMR through wastewater/recycled water” (29.6%) and “identifying types of AMR of clinical concern that might escape treatment” (25.9%) also ranked high. However, none of these monitoring objectives can be met without an agreed-upon framework and standard methods and approaches for monitoring AMR in aquatic environments.…”

Section: A Way Forward: Guidance From An Expert Survey and Workhopmentioning

confidence: 99%

See 1 more Smart Citation

Antimicrobial Resistance Monitoring of Water Environments: A Framework for Standardized Methods and Quality Control

Liguori

Keenum

Davis

et al. 2022

Environ. Sci. Technol.

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123

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Antimicrobial resistance (AMR) is a grand societal challenge with important dimensions in the water environment that contribute to its evolution and spread. Environmental monitoring could provide vital information for mitigating the spread of AMR; this includes assessing antibiotic resistance genes (ARGs) circulating among human populations, identifying key hotspots for evolution and dissemination of resistance, informing epidemiological and human health risk assessment models, and quantifying removal efficiencies by domestic wastewater infrastructure. However, standardized methods for monitoring AMR in the water environment will be vital to producing the comparable data sets needed to address such questions. Here we sought to establish scientific consensus on a framework for such standardization, evaluating the state of the science and practice of AMR monitoring of wastewater, recycled water, and surface water, through a literature review, survey, and workshop leveraging the expertise of academic, governmental, consulting, and water utility professionals.

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Section: Critical Research Needs Call For Standardized Methods For Am...mentioning

confidence: 99%

Section: A Way Forward: Guidance From An Expert Survey and Workhopmentioning

confidence: 99%

Antimicrobial Resistance Monitoring of Water Environments: A Framework for Standardized Methods and Quality Control

Liguori

Keenum

Davis

et al. 2022

Environ. Sci. Technol.

Self Cite

123

View full text Add to dashboard Cite

show abstract

“…The most comprehensive resistance monitoring study quantified ARGs in wastewater metagenomes in over 70 countries and found major differences in relative AMR abundances and classes in community sewage, reflecting large regional differences in 'local guts' (Hendriksen et al 2019). Furthermore, a recent review by Pruden et al (2021) described a range of applications of WBE for AMR monitoring including the following: (1) identification of hotspots to guide policy action on interventions; (2) inform medical and veterinary practitioners of the best antibiotics to use to avoid therapeutic failure; (3) inform risk assessments for discharge of antibiotics/ARB/ARGs into the wider environment; and (4) provide data for forecasting models and key drivers. Overall, the use cases for AMR surveillance using wastewater demonstrate the potential to add significantly to public health monitoring and therefore warrant further exploration.…”

Section: Antimicrobial Resistancementioning

confidence: 99%

Research needs for optimising wastewater-based epidemiology monitoring for public health protection

Robins

Leonard

Farkas

et al. 2022

Journal of Water and Health

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Wastewater-based epidemiology (WBE) is an unobtrusive method used to observe patterns in illicit drug use, poliovirus, and severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). The pandemic and need for surveillance measures have led to the rapid acceleration of WBE research and development globally. With the infrastructure available to monitor SARS-CoV-2 from wastewater in 58 countries globally, there is potential to expand targets and applications for public health protection, such as other viral pathogens, antimicrobial resistance (AMR), pharmaceutical consumption, or exposure to chemical pollutants. Some applications have been explored in academic research but are not used to inform public health decision-making. We reflect on the current knowledge of WBE for these applications and identify barriers and opportunities for expanding beyond SARS-CoV-2. This paper critically reviews the applications of WBE for public health and identifies the important research gaps for WBE to be a useful tool in public health. It considers possible uses for pathogenic viruses, AMR, and chemicals. It summarises the current evidence on the following: (1) the presence of markers in stool and urine; (2) environmental factors influencing persistence of markers in wastewater; (3) methods for sample collection and storage; (4) prospective methods for detection and quantification; (5) reducing uncertainties; and (6) further considerations for public health use.

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“…On the other hand, the dimension of environmental AMR remains unknown (Larsson et al, 2018;Samreen et al, 2021;Zhuang et al, 2021), and the interaction between pathogens and environmental bacteria carrying ARGs could be facilitated by horizontal gene transfer (Martínez, 2019). WHO recently launched the Tricycle project, which is aimed at One Health surveillance by focusing on extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli (Pruden et al, 2021;WHO, 2021b). However, monitoring targets and goals to control AMR in the environment is still challenging owing to the lack of basic information such as ARG abundance and diversity.…”

Section: Introductionmentioning

confidence: 99%

High-Throughput Screening of Antimicrobial Resistance Genes and Their Association With Class 1 Integrons in Urban Rivers in Japan

Kasuga

Nagasawa

Suzuki

et al. 2022

Front. Environ. Sci.

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Antimicrobial resistance (AMR) is a serious public health concern. Many countries have implemented AMR surveillance programs for humans and animals, but a scheme for monitoring AMR in the environment has not yet been established. Class 1 integrons, which can acquire antimicrobial resistance genes (ARGs) to gene cassettes, were proposed as a candidate to evaluate the anthropogenic impacts on AMR. However, the association between class 1 integrons and ARGs in aquatic environments is less studied and requires further elucidation. This study used high-throughput quantitative polymerase chain reaction (HT-qPCR) to characterize the pollution profiles of ARGs and mobile gene elements (MGEs) in 24 urban rivers in Tokyo and its surrounding area. The abundance of class 1 integron-integrase gene (intI1) and the array of class 1 integron gene cassettes were also determined. In total, 9–53 target genes were detected per sample, and their abundances increased following effluent discharge from wastewater treatment plants. The river and wastewater samples were categorized based on their HT-qPCR profiles, indicating that this method was useful for characterizing the pollution status in aquatic environments. The prevalence of intI1 in the rivers was observed. Some ARGs and MGEs were positively correlated with intI1, indicating that intI1 could be used as a proxy for monitoring these ARGs and MGEs in urban rivers. Long-read sequencing of class 1 integron gene cassettes revealed that one to three ARGs were present in the gene cassettes. Regardless of the sample type, blaGES-24, aadA2, and qacH were dominant in the gene cassettes. The source and spread of class 1 integrons carrying these ARGs in aquatic environments should be further monitored.

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Seizing the moment: now is the time for integrated global surveillance of antimicrobial resistance in wastewater environments

Cited by 77 publications

References 48 publications

Antimicrobial Resistance Monitoring of Water Environments: A Framework for Standardized Methods and Quality Control

Antimicrobial Resistance Monitoring of Water Environments: A Framework for Standardized Methods and Quality Control

Research needs for optimising wastewater-based epidemiology monitoring for public health protection

High-Throughput Screening of Antimicrobial Resistance Genes and Their Association With Class 1 Integrons in Urban Rivers in Japan

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