While therapeutic antibiotic use directly impacts the evolution of AntiMicrobial Resistance (AMR), it has become increasingly clear that the environmental dimension of AMR is also of great importance. There is mounting concern that wastewater systems, which receive antibiotic residues and antibiotic resistant organisms and their antibiotic resistance genes, could facilitate the environmental dissemination of resistance.
DARWIN has examined the fate of clinically relevant antibiotic resistances along sewer catchments and receiving waters in three European cities. We found that hospitals sewers contain higher concentrations of resistant bacteria than sewers in residential areas. Many of the resistance genes, and especially those in hospital wastewater, were carried on genetic elements that have potential to transfer rapidly from one bacterium to another.
We collected several other indications of the potential for microbial communities in wastewater systems to exchange resistance genes, yet we did not find direct evidence of such transfer, possibly because of the difficulty of the task (enormous amounts of bacteria transit across sewers and wastewater treatment plants). Overall, our data suggests that our wastewater collection and treatment systems discharge only few antibiotic resistant organisms and genes in the environment but the question of the impact of this low-level pollution remains unanswered.
We proposed a standard way for scientists to report their findings to facilitate data interpretation and reuse and built mathematical models to understand the dynamics of antibiotic resistance that will contribute to further development of mitigation strategies.
Impact of the study: DARWIN, through the obtained evidence and through its partners, has significantly contributed to wider efforts aimed at mitigating the spread of antibiotic resistance around the world. Such involvement has included science-informed public information on AMR (e.g., an invited Insights piece for the Conversation), co-authoring international recommendations for the World Health Organisation aimed at promoting local National Action Plans and socio-technical AMR mitigation options for countries around the world.
We also co-wrote guidance for the Wellcome Trust and US Centre for Disease Control and Prevention on essential initiatives to mitigate AMR; have been invited input providers to the USA PACCARB (Presidential Advisory Council on Combating Antibiotic Resistant Bacteria); and are members of the technical advisory council of ICARS (International Centre for Antimicrobial Resistance Solutions).
- Barth Smets, Technical University of Denmark, Denmark (Coordinator)
- Søren Johannes Sørensen, University of Copenhagen, Denmark
- David Graham, Newcastle University, United Kingdom
- Jan-Ulrich Kreft, University of Birmingham, United Kingdom
- Jesús L. Romalde, Universidade de Santiago de Compostela, Spain
- Carlos García-Riestra, University Hospital Complex of Santiago de Compostela – CHUS (Carlos GarcíaRiestra), Spain
- Mical Paul, Technion Israel Institute of Technology, Israel
- Article in The Telegraph (2020): Access to clean water may be as vital as cutting antibiotic use in the fight against superbugs
- Article in The Conversation (2020): Scientists around the world are already fighting the next pandemic
- Newcastle University news post (2016): Influencing international policy on antibiotic resistance
- Newcastle University Alumni YouTube channel: Fighting the next pandemic: Water Quality, antimicrobial resistance and global health
- Nature Communications, 2020. Discovery of multiple anti-CRISPRs highlights anti-defense gene clustering in mobile genetic elements