The Contribution of Wastewater to the Transmission of Antimicrobial Resistance in the Environment: Implications of Mass Gathering Settings

Abstract

Antimicrobial resistance (AMR) is the major issue posing a serious global health threat. Low- and middle-income countries are likely to be the most affected, both in terms of impact on public health and economic burden. Recent studies highlighted the role of resistance networks on the transmission of AMR organisms, with this network being driven by complex interactions between clinical (e.g., human health, animal husbandry and veterinary medicine) and other components, including environmental factors (e.g., persistence of AMR in wastewater). Many studies have highlighted the role of wastewater as a significant environmental reservoir of AMR as it represents an ideal environment for AMR bacteria (ARB) and antimicrobial resistant genes (ARGs) to persist. Although the treatment process can help in removing or reducing the ARB load, it has limited impact on ARGs. ARGs are not degradable; therefore, they can be spread among microbial communities in the environment through horizontal gene transfer, which is the main resistance mechanism in most Gram-negative bacteria. Here we analysed the recent literature to highlight the contribution of wastewater to the emergence, persistence and transmission of AMR under different settings, particularly those associated with mass gathering events (e.g., Hajj and Kumbh Mela).

The potential impact of the COVID-19 pandemic on global antimicrobial and biocide resistance: an AMR Insights global perspective

“… 95–99 Additionally, the intensive use of surface disinfectants and household cleaners contribute to an increased concentration of these substances in wastewater treatment plants and receiving waters, altering the normal ecosystem and potentially favouring the emergence of AMR due to biocide-related selection pressure. 100 , 101 Moreover, in densely populated countries, where the use of disinfectants was mostly confined to the clinical/healthcare settings, the increased use of hand sanitizers and disinfectants might potentially impact on the human microbiome, which contributes to maintaining homeostasis in and on its host. According to the Scientific Advisory Board of the British Institute of Cleaning Sciences, the killing activity of alcohol-based sanitizers for SARS-CoV-2 has not yet been proven.…”

Prevalence and Traits of Mobile Colistin Resistance Gene Harbouring Isolates from Different Ecosystems in Africa

“…(1) Wastewater . Wastewaters are contaminated fluids from anthropogenic and agricultural settings, which contain nutrients that support the growth of bacteria and rapid exchange of MGEs [ 74 ]. Thus, wastewaters are established sources of new emerging pathogenic antimicrobial-resistant organisms.…”

Pathogenicity of Shiga Toxin Type 2e Escherichia coli in Pig Colibacillosis

“…The observed high level of resistance to tetracycline and ampicillin is probably a direct consequence of the intense use of these antibiotics in veterinary medicine. In addition, the horizontal transfer of these resistant genes should be considered together with their potential acquisition from a contaminated external environment ( 58 , 59 ). We found that, besides the high rate of resistance to most of the tested antimicrobials, the majority of Stx2e-producing isolates isolated from pigs also exhibited multidrug resistance.…”