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

Nour Fouz,Krisna N A Pangesti,Esam I Azhar,Abdulrahman L Al-Malki,Grant A Hill-Cawthorne,Muhammad Yasir,Moataz Abd El Ghany

doi:10.3390/tropicalmed5010033

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).

Highlights

IntroductionSince the development of fluoroquinolones in early 1970, no new major groups of antibacterial drugs have been developed [1]
We systematically analysed the recent literature to highlight the contribution of different types of wastewaters from various sources to the emergence, persistence and transmission of antimicrobial resistant (AMR) in environments and their potential impacts on public health
The analysed studies highlighted the role of wastewaters as major sources of antimicrobial agents, AMR bacteria (ARB) and antimicrobial resistant genes (ARGs) in the environment

Summary

Introduction

Since the development of fluoroquinolones in early 1970, no new major groups of antibacterial drugs have been developed [1] This paucity in development is accompanied by an increasing threat of antimicrobial resistant (AMR) organisms [1,2]. The World Health Organization (WHO) Global Antimicrobial Surveillance System (GLASS) reported increased levels of resistance in a number of serious and common bacterial infections in many regions of the world [6]. The European Center for Disease Prevention and Control (ECDC) and the US Centers for Disease Control and Prevention (CDC) have reported that AMR infections resulted in 25,000 and 23,000 deaths every year in high-income countries in Europe and the USA, respectively [7]. In low- and middle-income countries, AMR infections have been responsible for the deaths of 58,000 children and 38,000 adults in India and Thailand, respectively [7]

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