Abstract
Ambient recreational waters can act as both recipients and natural reservoirs for antimicrobial resistant (AMR) bacteria and antimicrobial resistant genes (ARGs), where they may persist and replicate. Contact with AMR bacteria and ARGs potentially puts recreators at risk, which can thus decrease their ability to fight infections. A variety of point and nonpoint sources, including contaminated wastewater effluents, runoff from animal feeding operations, and sewer overflow events, can contribute to environmental loading of AMR bacteria and ARGs. The overall goal of this article is to provide the state of the science related to recreational exposure and AMR, which has been an area of increasing interest. Specific objectives of the review include (1) a description of potential sources of antibiotics, AMR bacteria, and ARGs in recreational waters, as documented in the available literature; (2) a discussion of what is known about human recreational exposures to AMR bacteria and ARGs, using findings from health studies and exposure assessments; and (3) identification of knowledge gaps and future research needs. To better understand the dynamics related to AMR and associated recreational water risks, future research should focus on source contribution, fate and transport—across treatment and in the environment; human health risk assessment; and standardized methods.
Highlights
The increasing rise of antimicrobial resistance (AMR) is one of the greatest threats to human health in the 21st century [1,2,3]
It is estimated that death is 64% more likely in people infected with methicillin-resistant Staphylococcus aureus (MRSA)
Since this study only considered resistance to 3GCs, it likely underestimates the true recreational exposure to
Summary
The increasing rise of antimicrobial resistance (AMR) is one of the greatest threats to human health in the 21st century [1,2,3]. Antibiotics remain important for treating both minor and life-threatening bacterial infections. They are essential for the prevention of infection following surgical procedures and in the administration of treatments that depress the immune system, including the administration of chemotherapeutic agents to cancer patients [4,5]. Patients with infections caused by resistant bacteria are at increased risk of adverse clinical outcomes and consume more health-care resources than patients infected with non-resistant or sensitive strains of the same bacteria [6]. As pathogens develop resistance to multiple antibiotics, there is a risk that treatment failures using last resort antibiotics will occur more
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