Antimicrobial Resistance Monitoring of Water Environments: A Framework for Standardized Methods and Quality Control

Abstract

Antimicrobial resistance (AMR) is a grand societal challenge with important dimensions in the water environment that contribute to its evolution and spread. Environmental monitoring could provide vital information for mitigating the spread of AMR; this includes assessing antibiotic resistance genes (ARGs) circulating among human populations, identifying key hotspots for evolution and dissemination of resistance, informing epidemiological and human health risk assessment models, and quantifying removal efficiencies by domestic wastewater infrastructure. However, standardized methods for monitoring AMR in the water environment will be vital to producing the comparable data sets needed to address such questions. Here we sought to establish scientific consensus on a framework for such standardization, evaluating the state of the science and practice of AMR monitoring of wastewater, recycled water, and surface water, through a literature review, survey, and workshop leveraging the expertise of academic, governmental, consulting, and water utility professionals.

Keywords: antibiotic resistance; recycled water; standardization; surface water; surveillance; wastewater.

Figure 1

Monitoring objectives and transmission pathways for antimicrobials, resistant microorganisms, mobile genetic elements (MGEs), and antibiotic resistance genes (ARGs) in humans and the environment.

Figure 2

Decision tree for selecting culture-, qPCR-, or metagenomics-derived monitoring methods for AMR monitoring of wastewater, recycled water, or surface water, depending on the monitoring objective. Dashed lines indicate the potential for enhanced realization of research objectives when molecular methods are coupled with culture. WBE, wastewater-based epidemiology.