Antimicrobials and antimicrobial resistance genes in the shadow of COVID-19 pandemic: A wastewater-based epidemiology perspective

Like Xu, Nicola Ceolotto, Kishore Jagadeesan, Richard Standerwick, Megan Robertson, Ruth Barden, Barbara Kasprzyk-Hordern

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Higher usage of antimicrobial agents in both healthcare facilities and the communities has resulted in an increased spread of resistant bacteria. However, the improved infection prevention and control practices may also contribute to decreasing antimicrobial resistance (AMR). In the present study, wastewater-based epidemiology (WBE) approach was applied to explore the link between COVID-19 and the community usage of antimicrobials, as well as the prevalence of resistance genes. Longitudinal study has been conducted to monitor the levels of 50 antimicrobial agents (AAs), 24 metabolites, 5 antibiotic resistance genes (ARGs) and class 1 integrons (intI 1) in wastewater influents in 4 towns/cities over two years (April 2020 - March 2022) in the South-West of England (a total of 1,180 samples collected with 87,320 individual AA measurements and 8,148 ARG measurements). Results suggested higher loads of AAs and ARGs in 2021–22 than 2020–21, with beta-lactams, quinolones, macrolides and most ARGs showing statistical differences. In particular, the intI 1 gene (a proxy of environmental ARG pollution) showed a significant increase after the ease of the third national lockdown in England. Positive correlations for all quantifiable parent AAs and metabolites were observed, and consumption vs direct disposal of unused AAs has been identified via WBE. This work can help establish baselines for AMR status in communities, providing community-wide surveillance and evidence for informing public health interventions. Overall, studies focused on AMR from the start of the pandemic to the present, especially in the context of environmental settings, are of great importance to further understand the long-term impact of the pandemic on AMR.

Original languageEnglish
Article number121665
Number of pages19
JournalWater Research
Early online date22 Apr 2024
Publication statusE-pub ahead of print - 22 Apr 2024

Data Availability Statement

All data is available in the manuscript.


The authors would like to thank Prof. Samuel K Sheppard and Dr Ben Pascoe from the Milner Centre for Evolution, University of Bath for approving the access to the AriaMx Real-Time PCR platform.


  • Antibiotic resistance genes (ARGs)
  • Antibiotics
  • Antimicrobial resistance
  • COVID-19 pandemic
  • Wastewater-based epidemiology

ASJC Scopus subject areas

  • Environmental Engineering
  • Civil and Structural Engineering
  • Ecological Modelling
  • Water Science and Technology
  • Waste Management and Disposal
  • Pollution

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