Wastewater as a Sentinel for Emerging Antimicrobial Resistance Threats: A Review

Antimicrobial resistance (AMR) represents a global health crisis, threatening to render many of our most effective antibiotics obsolete. Traditional surveillance methods, which focus on symptomatic patients, provide a reactive and limited view of resistance trends, often overlooking the early indicators of emerging AMR threats. This review advocates for a paradigm shift in AMR surveillance, emphasizing the potential of wastewater-based epidemiology (WBE) as a proactive, real-time monitoring tool. By harnessing advanced molecular techniques, WBE offers an unprecedented opportunity to track antimicrobial resistance genes (AMRGs) in populations, even in areas with limited healthcare infrastructure. Rather than merely counting pathogens, WBE allows for the detection of subtle shifts in the resistome, providing a clearer picture of resistance dynamics before they reach clinical settings. This approach not only offers early warnings of potential resistance outbreaks but also enables global surveillance, contributing to a more comprehensive understanding of AMR trends and the effectiveness of mitigation strategies. Ultimately, wastewater surveillance is poised to become a cornerstone in the fight against AMR, offering a forward-looking approach to safeguarding the efficacy of antibiotics for future generations.