Towards monitoring of antimicrobial resistance in the environment: For what reasons, how to implement it, and what are the data needs?
Review article, 2023
Antimicrobial resistance (AMR) is a global threat to human and animal health and well-being. To understand AMR dynamics, it is important to monitor resistant bacteria and resistance genes in all relevant settings. However, while monitoring of AMR has been implemented in clinical and veterinary settings, comprehensive monitoring of AMR in the environment is almost completely lacking. Yet, the environmental dimension of AMR is critical for understanding the dissemination routes and selection of resistant microorganisms, as well as the human health risks related to environmental AMR. Here, we outline important knowledge gaps that impede implementation of environmental AMR monitoring. These include lack of knowledge of the ‘normal’ background levels of environmental AMR, definition of high-risk environments for transmission, and a poor understanding of the concentrations of antibiotics and other chemical agents that promote resistance selection. Furthermore, there is a lack of methods to detect resistance genes that are not already circulating among pathogens. We conclude that these knowledge gaps need to be addressed before routine monitoring for AMR in the environment can be implemented on a large scale. Yet, AMR monitoring data bridging different sectors is needed in order to fill these knowledge gaps, which means that some level of national, regional and global AMR surveillance in the environment must happen even without all scientific questions answered. With the possibilities opened up by rapidly advancing technologies, it is time to fill these knowledge gaps. Doing so will allow for specific actions against environmental AMR development and spread to pathogens and thereby safeguard the health and wellbeing of humans and animals.
AMR
One-health
Antibiotic resistance
Infectious diseases
Surveillance
Transmission
Author
Johan Bengtsson-Palme
Chalmers, Life Sciences, Systems and Synthetic Biology
University of Gothenburg
Anna Abramova
University of Gothenburg
Chalmers, Life Sciences, Systems and Synthetic Biology
Thomas U. Berendonk
Technische Universität Dresden
Luis P. Coelho
Fudan University
Sofia K. Forslund
The Max Delbrück Center for Molecular Medicine
German Center for Cardiovascular Research DZHK
Charité University Medicine Berlin
European Molecular Biology Laboratory
Rémi Gschwind
Paris Descartes University
Annamari Heikinheimo
Finnish Food Authority
University of Helsinki
Víctor Hugo Jarquín-Díaz
The Max Delbrück Center for Molecular Medicine
Charité University Medicine Berlin
Ayaz Ali Khan
University of Malakand
Quaid-i-Azam University
Uli Klümper
Technische Universität Dresden
Ulrike Löber
The Max Delbrück Center for Molecular Medicine
Charité University Medicine Berlin
Marmar Nekoro
Medical Products Agency
Adriana D. Osińska
Norwegian University of Life Sciences
Svetlana Ugarcina Perovic
Fudan University
Tarja Pitkänen
Finnish Institute for Health and Welfare
University of Helsinki
Ernst Kristian Rødland
Norwegian Institute of Public Health
Etienne Ruppé
Paris Descartes University
Yngvild Wasteson
Norwegian University of Life Sciences
Astrid Louise Wester
Norwegian Institute of Public Health
Rabaab Zahra
Quaid-i-Azam University
Environment International
0160-4120 (ISSN) 1873-6750 (eISSN)
Vol. 178 108089EMBARK: Establishing a Monitoring Baseline for Antibiotic Resistance in Key environments
Swedish Research Council (VR) (2019-00299), 2022-05-01 -- 2023-12-31.
Predicting future pathogenicity and antibiotic resistance
Swedish Foundation for Strategic Research (SSF) (FFL21-0174), 2022-08-01 -- 2027-12-31.
Subject Categories (SSIF 2011)
Public Health, Global Health, Social Medicine and Epidemiology
DOI
10.1016/j.envint.2023.108089
PubMed
37441817