The European Environment Agency (EEA) has released a study emphasizing the need for monitoring antimicrobial resistance (AMR) to enhance public health protection. The study highlights the importance of establishing Europe-wide monitoring of AMR in aquatic environments.
Monitoring AMR in surface waters is essential to evaluate the risk of resistance transmission to humans, according to the EEA briefing titled ‘Antimicrobial resistance in surface waters’. Recognizing AMR in the environment as a vital component of the EU’s One Health Action Plan and with new EU regulations like the revised Urban Wastewater Treatment Directive mandating monitoring by 2030, countries must initiate monitoring programs for this newly identified water-related risk.
Antibiotics and antibiotic-resistant bacteria naturally exist in the environment, but major contributors include human and veterinary antibiotic use. Discharges from pharmaceutical industries, urban wastewater, treated sewage sludge, and agricultural practices can introduce antibiotic resistance into the environment.
Natural environments can serve as reservoirs for resistant microorganisms, promoting the development and selection of antibiotic resistance genes. These genes’ transfer among microorganisms occurs naturally, yet human activities, pollution, and temperature can intensify this process, as per the EEA briefing.
Evidence points to environmental AMR contributing to resistance’s development and spread, posing threats to human and animal health.
AMR monitoring in surface waters would supplement existing monitoring in sectors such as food and animal health. The EEA briefing outlines elements needed for establishing robust, Europe-wide environmental AMR monitoring, including clear goals, standardized sampling methods and protocols, strong quality and control measures, and a centralized data reporting system. This guidance is based on findings from an EEA network working group pilot study with experts from 14 European nations.
Environmental monitoring can pinpoint AMR hotspots, assess its spread and transmission vectors, provide trends and emerging gene data, track waste management interventions’ effectiveness, and enhance our understanding of AMR-related risks.
The EU has undertaken notable actions against antimicrobial resistance, including the One Health approach and its action plan, underlining the significance of comprehensive surveillance and monitoring.
EU water-related legislation has also begun addressing the urgency for AMR monitoring and reporting. For instance, the revised Urban Wastewater Treatment Directive specifies monitoring AMR in urban wastewater, and proposed amendments to the Water Framework Directive, the Environmental Quality Standards Directive, and the Groundwater Directive aim to include AMR indicators in surface and groundwater watch lists and develop AMR monitoring methodologies.
Antimicrobial resistance is a leading global public health threat, as declared by the World Health Organization. The health impact of AMR infections rivals that of major diseases like HIV and malaria and could potentially surpass them. AMR results in infections that are tougher to treat, leading to longer illnesses, higher healthcare expenses, and increased mortality rates. Projections indicate up to 1.9 million AMR-attributable deaths and 8.2 million associated deaths globally by 2050. More than 35,000 individuals die annually from antibiotic-resistant infections in the EU, Iceland, and Norway, a figure that has risen recently, according to the European Centre for Disease Control (ECDC).
Key AMR drivers include overprescribing and misuse of antibiotics in healthcare and veterinary contexts, prompting microorganism resistance development against antimicrobial compounds. Discharges from hospitals and wastewater treatment facilities can also disseminate antibiotic-resistant bacteria (ARB) and/or antibiotic resistance genes (ARGs) into the environment. Consequently, the environment is increasingly recognized as a crucial AMR reservoir, potentially playing a significant role in its dissemination.
This EEA briefing is based on a pilot study by the Eionet Working Group on AMR in surface waters, conducted in 2024 and reported earlier this year.
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