Wastewater-Based Epidemiology for Monitoring Community derived Antibiotics and Resistant Genes

Antimicrobial resistance (AMR) has been hailed as one of the critical public
health threats facing 21st century. The discovery and wide-spread availability of
antibiotics since the 1970s revolutionized medicine, however over-prescribing has
resulted in the increased development of multi-drug resistance in pathogens.
Current AMR surveillance within populations relies heavily on clinical data. This
however covers only a small proportion of the community as samples are from
those who have seeked medical aid, hence might not be representative of the
wider population. Wastewater-based epidemiology (WBE) is a promising
approach of sampling influent wastewater for biomarkers in order to give public
health information on the population that has contributed. The analysis of AMR
related biomarkers in WBE could therefore provide key spatiotemporal and
comprehensive information on resistance circulating in communities giving
complimentary information to current AMR clinical data.This study presents
results from a year-long study in two catchment areas in the South-West
combining the analysis of antibiotics, metabolites and resistance genes in influent
wastewater to investigate AMR within populations. Using advanced analytical
tools, chemistry and biological techniques have been combined together to give
insight to the antimicrobial patterns and resistance of two communities Over 200
influent wastewater samples have been collected from two different catchment
areas, with up to ten 24-hr composite samples from each site per month. Over 60
different antibiotics and metabolites covering a range of different classes have
been investigated. Next generation DNA sequencing along with dPCR on
seasonally relevant samples have given insight to the diversity of resistant genes
present in wastewater. Catchment prescription data of antibiotics demonstrates
seasonal prescribing patterns which is reflected from wastewater analysis.