What do we know about antimicrobial resistance in aquatic environments? On the release of an important new Special Issue, Editors of Journal of Water & Health tell us more about this crucial topic in water and sanitation.
"Updated research agenda for water, sanitation and antimicrobial resistance"
Maronel Steyn, Tasha M. Santiago-Rodriguez, Daisuke Sano & Gary Toranzos
What’s the focus of this Special Issue and why is it important?
Although antibiotic resistance is being discussed in other contexts, this, to the best of our knowledge, represents one of the few special issues focused specifically in the water environment.
Contributions to the Special Issue include original research, reviews and commentaries on the occurrence, distribution, prevalence and surveillance of antimicrobial resistance genes in water environments, sewage, activated sludge and in wastewater reuse, and a number of different techniques have been applied in such efforts. As antibiotic-resistance is a global concern to public health, contributions to the Special Issue represent collaborations from various countries.
The Special Issue is important as it highlights the current knowledge base and the progress that has been made to date, as well as the large number of questions that are still unanswered.
How is antimicrobial resistance significant in water and health?
Access to water has been deemed a human right, however, good water quality should also be strived for. The presence of not only microbial enteric pathogens, but also saprophytic microorganisms that are antibiotic resistant, present a unique problem to those of us who work in water and public health. Our main concern has been pathogens that are antibiotic resistant, but the microbiota that is antibiotic resistant present an even more difficult problem in terms of control. Although sewage emanating from hospitals may present a special problem in terms of enteric pathogens and antibiotic resistance, the entire population (including asymptomatic members of the population) are excreting enteric pathogens and use oral antibiotics from time to time that ultimately end up in the sewage and the environment.
The collection of articles included in the Special Issue allows one to assess the prevalence and occurrence of antimicrobial resistance in water environments, open the opportunity to further identify hotspots, understand transmission dynamics and determine potential effects of antimicrobial resistance genes to public health.
What new areas of research in antimicrobial resistance are particularly exciting?
The mere fact that we are looking at the total microbiota in water and sewage and looking at it in terms of the "resistome" (i.e., all of the antimicrobial resistance genes) opens up many research opportunities. We hope that this issue will not only answer some questions, but will also give public health sectors a tool that can be used to ameliorate the ongoing problem of antibiotic resistance in the population.
We are also venturing into understanding the dynamics and evolution of antimicrobial resistance, not only in the clinical setting, but also in environmental settings, including water environments, which are usually underestimated. New research using high-throughput sequencing, for example, is also aiding to understand the effect of infrastructure damage after hurricanes in the introduction and spread of antimicrobial resistance genes. The transfer efficiency of antimicrobial resistance genes in water environments between bacterial strains through conjugation and natural transformation need to be better understood, to allow us to determine the number of genes that should be removed from wastewater. These open the opportunity to understand the effect of this and other natural events in various geographical regions in the spread of antimicrobial resistance genes.