A review of wastewater-based epidemiology for antimicrobial resistance surveillance

Antimicrobial resistance (AMR) is recognized as one of the most serious threats to public health. Unparalleled population growth and accelerated rates of AMR emergence and dissemination have resulted in both novel resistance in pathogenic organisms and the re-appearance of infections that were formerly under control. Consequently, this has led to an increased quantity of infectious diseases. One of the main drivers of antimicrobial overuse is inappropriate prescribing in human and veterinary medicine. The ability to rapidly survey the spread of antimicrobial resistance within human populations is key for its prevention, intervention, and control. However, many constraints are present for current clinical surveillance systems and their capacity to determine AMR dynamics in the microbiome of healthy individuals as well as in clinical pathogens causing infections. Wastewater-based epidemiology (WBE) is an emergent technique that has the capacity to act as a supplementary measure for current infectious disease surveillance systems and as an early warning system for infectious disease outbreaks. The development of disease outbreaks to the community level can be monitored in real time through the analysis of population pooled wastewater. This review provides an introduction to using wastewater-based epidemiology to monitor AMR bacteria, as well as an overview of wastewater-based epidemiology and its components.