Antibiotic resistance is one of the most urgent threats to global health. It is estimated that antibiotic resistance was associated with around 4,95 million deaths in 2019, making it the third leading Global Burden of Disease (GBD) Level 3 cause of death in that year. The number of deaths is expected to increase significantly in the coming years, as antibiotics lose their effectiveness and bacterial infections become more deadly. Moreover, antibiotic resistance is a complex problem and tackling it requires a One Health approach, as resistant bacteria spread in humans, animals, and the environment.
The World Health Organisation proposed an action plan on antibiotic resistance, which emphasizes the importance of monitoring and research. But the monitoring of antibiotic resistance in the environment has received less attention compared to in humans and animals, which has been done for a long time. Environmental monitoring is essential to identify the “hotspots”, which are certain environments where resistance is known to develop and spread. Hospitals, wastewater treatment plants, pharmaceutical factories, and food and animal production facilities are known as the hotspots of environmental antibiotic resistance due to the constant use and or production of antibiotics. The monitoring can be also used to evaluate how resistance spreads into and from different environments, and how the resistance levels change over time. Studies show that more resistance is observed in regions where the use of antibiotics is higher and where the environment is contaminated with human waste and antibiotics. Monitoring efforts should also focus on low- and middle-income countries, which often have limited resources but a high burden of antibiotic resistance. To understand and prevent the spread of antibiotic resistance, various stakeholders are interested, or required, to monitor antibiotic resistance. With monitoring data, scientists and decision-makers can better understand antibiotic resistance and so develop effective strategies to mitigate the spread. It can provide early warnings of emerging threats and help identify long-term trends.
With monitoring data, scientists and policymakers can better understand antibiotic resistance to develop strategies to mitigate the spread
The release of wastewater from the mentioned hotspots into the aquatic environments can further spread the resistance to different environmental compartments which will, eventually, spread to humans and animals. This emphasizes the importance of wastewater monitoring to identify the main sources of antibiotic resistance in the environment. Wastewater monitoring will be a potentially valuable addition to current antibiotic resistance monitoring in humans and animals since it can provide comprehensive information on the levels of resistance in the monitored areas. Wastewater monitoring can also cover a wider range of antibiotic resistance profiles which are often carried by commensal bacteria compared to the partial data from pathogenic bacteria isolated from humans and animals. Currently, the monitoring of antibiotic resistance in wastewater is being performed mainly at in-house laboratories with less comprehensive and more costly technologies in governmental research institutes and or university laboratories that lack appropriate quality management systems. This also emphasizes the need for a commercial service that can provide faster, more comprehensive and quality-controlled service to the various stakeholders.
On the other hand, wastewater monitoring has been used as a monitoring tool to assess population health concerning the use of illegal drugs and the success of polio control measures. In recent years, wastewater monitoring has been used also to monitor the COVID-19 epidemic situation. Wastewater monitoring of antibiotic resistance can be used to identify the trend of antibiotic resistance development and help prioritize measures and interventions to control the situation and assess its effectiveness. It is important that different methods are studied to develop both monitoring and better wastewater treatment.