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Standardizing Quantitative Assessment of Antimicrobial Resistance to Inform Risk
Citation:
Garland, J., A. Pruden, K. Hamilton, AND R. Gonzalez. Standardizing Quantitative Assessment of Antimicrobial Resistance to Inform Risk. WateReuse 2023 Symposium, Atlanta, GA, March 05 - 08, 2023.
Impact/Purpose:
Summarizing current thinking on AMR risk in water systems for a audience at the annual water refuse conference.
Description:
Antimicrobial resistance (AMR) has been identified as one of the major public health threats of the 21st Century. In 2019, 2.8 million American were infected with antibiotic resistant bacteria, leading to over 35,000 deaths and between $21-24 billion in health care costs. Global deaths directly attributable to AMR infections were 1.27 million in 2019, with estimates of over 10 million (more than from cancer) by 2030. The magnitude of the issue has lead countries worldwide to develop multifaceted action plans to combat AMR, including improved stewardship of antibiotics, development of new antimicrobials, and advanced surveillance. The US Federal Government established a national surveillance system to monitor antimicrobial resistance in zoonotic bacteria from both food animals and humans in 1996, and has recently expanded these efforts to include environmental analysis, adopting an interdisciplinary, “One Health” model of infectious disease monitoring and control. Evaluation of AMR in water systems, including both built and natural components, is important to a robust One Heath approach. Wastewater is an important link between human generated contamination and the environment, which can lead to waterborne exposures through recreational activities or de facto reuse. Planned reuse also needs to mitigate risk from AMR bacteria. Current thinking on the environmental dimensions of the AMR emphasize 1) the need for standardized sampling and analysis to facilitate comparison of rapidly expanding data sets, 2) the development of quantitative modeling approaches to translate measurements into risks, and 3) statistically robust sampling plans to define the relative contributions of different sources of AMR and the factors affecting implications and transmission of AMR. This panel focuses on these elements by presenting the findings from 2 recent Water Research Foundation addressing topics 1 and 2, and reviewing current and planned efforts by the USEPA to develop national-scale sampling of wastewater and its impacts on surface water. Discussion will include the utility-specific relevance of the current research activities to near-term opportunities for collaboration and potential longer term changes in operation.