The ‘thanato-resistome’ - The funeral industry as a potential reservoir of antibiotic resistance: Early insights and perspectives

Abstract

The funeral industry is a potential reservoir of antibiotic resistance. The occurrence, human exposure and health risks of antibiotic resistance in the funeral industry were examined. The funeral industry harbours antibiotic resistance to multiple common and last-resort antibiotics, hence constitutes the ‘ thanato-resistome ’. Hydrological processes, air-borne particulates and vectors disseminate antibiotic resistance, while horizontal gene transfer circulates antibiotic resistance among resistomes, forming a complex network. Ingestion, inhalation of air-borne particulates, dermal intake and clothes of workers contribute to human exposure. Human health risks include; development of drug resistance in previously susceptible pathogens, and increased morbidity and mortality caused by increased pathogenicity and outbreaks of multi-drug resistant infections. Ecological risks include the proliferation of resistant organisms at the expense of susceptible ones, thereby disrupting ecosystem structure and function, including biogeochemical cycles. Barring inferential data, quantitative evidence linking antibiotic resistance to human infections is weak. This reflects the lack of systematic quantitative studies, rather than the absence of such health risks. Quantitative risk assessment is constrained by lack of quantitative data on antibiotic resistance in various reservoirs and exposure routes. A framework for risk assessment and mitigation is proposed. Finally, ten hypotheses and emerging tools such as genomics, in silico techniques and big data analytics are highlighted.

Wastewater, waste, and water-based epidemiology (WWW-BE): A novel hypothesis and decision-support tool to unravel COVID-19 in low-income settings?

“…Some may argue that, besides validating earlier results in new geographical settings, subsequent studies may provide limited new insights relative to the pioneering ones. The bias induced by the bandwagon or Matthew effect may have adverse effects on decision-making in research priorities and even research funding (Daughton, 2014;Gwenzi, 2020c). Collectively, the bandwagon or Matthew effect, and the North-South knowledge asymmetry may account for the limited research progress on SARS-CoV-2 detection in shared on-site sanitation facilities, surface water and groundwater systems, and drinking water supply systems in LICs.…”

Insects, Rodents, and Pets as Reservoirs, Vectors, and Sentinels of Antimicrobial Resistance

“…These risk factors include (1) a putatively high number of stray animals, including dogs and cats [ 238 ]; (2) a high burden of both animals and human diseases due to a predominantly tropical environment [ 10 , 13 ], resulting in a corresponding high use, misuse and abuse of antimicrobials in animal and human health [ 239 ]; and (3) terrestrial, aquatic and atmospheric systems highly polluted by chemical agents including antimicrobials, pharmaceuticals, and metals that select for antimicrobial resistance [ 240 ]. Moreover, developing countries have weak and poorly enforced animal, human, and environmental health regulations, while early detection and mitigation of AMR is challenging due to a lack of systematic surveillance systems [ 13 ]. Therefore, the lack of research in socio-economic settings with high-risk factors where conditions are ideal to understand AMR in insects, rodents, and companion animals and its health risks, is ironic.…”

“…Yet, these emerging tools have the potential to complement existing conventional methods and provide further insights into the complex behavior of AMR. The generic applications of emerging and novel analytical tools in AMR research are discussed in an earlier paper focusing on AMR in the funeral industry [ 13 ]. Here, potential applications of the emerging and novel tools in the context of AMR in the environment–animal–human interface are highlighted.…”

“…The existing literature on AMR, including review papers, focused on the following aspects, among several others—(1) human infections, including nosocomial ones or those associated with healthcare facilities [ 7 , 8 ], (2) occurrence in animal production systems [ 9 ], and (3) occurrence, fate, and health risks of AMR in various environmental compartments [ 10 ]. To date, AMR was reported in the following environmental compartments—(1) human-impacted soils [ 11 ], (2) industrial and municipal wastewater systems [ 12 , 13 ], (3) surface water and groundwater systems, including drinking water systems [ 14 ], and (4) ambient environments including particulate matter and aerosols [ 15 , 16 ]. A wide range of antimicrobial-resistant microorganisms and antimicrobial resistance genes of human health concern were detected, including the ESKAPE pathogens [ 5 , 6 , 10 ].…”

Preliminary study of graveyard soil as a potential source of AMR - analysis of exhumation soil samples from the New Cemetery in Chełmża, Poland

“…the unknown status regarding the cause of death, multitude of microorganisms present inside and outside the corpse, numerous gene transfer mechanisms and their high rate of mutation, make the cemetery soil a possible reservoir of antibiotic resistance. The few studies dealing with this issue [20][21][22] support this assumption.…”