Moving antimicrobial resistance (AMR) up the agenda

As the dominance of Covid-19 on the public health agenda subsides, it’s time to reflect anew on the significant issue of antimicrobial resistance (AMR) – a public health and environmental challenge that has been growing in prominence in recent years, and which shows no signs of slowing down.

AMR develops when microbes evolve so that they do not respond to antimicrobial substances, such as antibiotics. This process can happen for a number of reasons, including exposure of microbial organisms to antimicrobial chemicals.

The World Health Organization (WHO) has declared AMR “one of the top ten global public health threats facing humanity”. And rightly so – it increases the development of drug-resistant pathogens – or superbugs – which have the potential to jeopardise modern medicine, making infections harder to treat, and significantly increasing the risks associated with common medical procedures/treatment, such as surgery and chemotherapy.

While public health campaigns have raised awareness of the need to reduce unnecessary antibiotic use in humans, it remains a problem across the world; and antibiotic usage is also widespread in farming and aquaculture.

Another potential contributor to AMR is the use of everyday biocide products (e.g. Short et al., 2021) – including surface disinfectants and hand sanitisers. Such substances, although necessary in certain settings and situations, require responsible use. The use of biocides increased dramatically during Covid-19, and there are some indications that this has enhanced the prevalence of environmental AMR (e.g. Mahoney et al., 2021; Mohapatra et al., 2023; Hu et al., 2023).

The environment can be a key reservoir for AMR. Routes of AMR from the environment to humans include sewage (e.g. Nguyen et al., 2021; Samreen et al., 2021; Larsson et al., 2023). Although further work is ongoing in this area, research has indicated that users of natural coastal recreational waters can be exposed to AMR via this route (e.g. Leonard et al., 2015; Farrell, M.L. et al., 2021). The UK government has acknowledged the severity of the AMR risk for our society, and has put together a key 20-year vision and 5-year plan to tackle AMR, which includes a particular focus on minimising the spread of AMR through the environment. 

The Atkins water quality team has been working with clients to explore the presence of environmental AMR, and we have developed strong expertise in this important specialist field, working with world-leading scientists in the sector.

We have undertaken Evidence Reviews for the Department for the Environment, Food & Rural Affairs reviewing latest knowledge and understanding on aspects of AMR. We have also worked with the Environment Agency, and in collaboration with UKCEH, on bringing together a wide range of datasets relating to AMR into an easy-to-use geodatabase; as well as selecting pilot sites for an AMR surveillance programme, which will provide valuable information on the presence of environmental AMR. This work recently featured in the Chief Scientist’s Annual Review report about key issues affecting the environment.

There is plenty we can do to alleviate the severity of AMR going into the future, but we need to begin to acknowledge it as an urgent issue and increase awareness and education. Dame Sally Davies (previous Chief Medical Officer for England) said that ‘Antibiotic resistance could kill us before the climate crisis does’, yet public perception of AMR is not even close to being on a par with other issues, where we have seen considerable changes in attitudes and behaviours over the past decade.

As the WHO continues to push for the prioritisation of AMR across the global community, we all need to move AMR up the agenda - raising awareness and changing behaviours at all levels in all nations to tackle a challenge together that affects us all.

References

Farrell et al., 2021. Evaluating the potential for exposure to organisms of public health concern in naturally occurring bathing waters in Europe: A scoping review. Water Research, 206, 117711.

Hu et al., 2023. Excessive disinfection aggravated the environmental prevalence of antimicrobial resistance during COVID-19 pandemic. Science of the Total Environment, 882, 163598.

Larsson et al., 2023.Sewage surveillance of antibiotic resistance holds both opportunities and challenges. Nature Reviews Microbiology, 21: 213-214.

Leonard et al., 2015. Human recreational exposure to antibiotic resistant bacteria in coastal bathing waters. Environment International Volume 82: 92-100.

Mahoney et al., 2021. The silent pandemic: Emergent antibiotic resistances following the global response to SARS-CoV-2. iScience, 24: 102304

Mohapatra et al., 2023. Quaternary ammonium compounds of emerging concern: Classification, occurrence, fate, toxicity and antimicrobial resistance. Journal of Hazardous Materials, 445: 130393

Nguyen et al., 2021. Monitoring antibiotic resistance genes in wastewater treatment: Current strategies and future challenges. Science of the Total Environment, 783:146964.

Samreen et al., 2021. Environmental antimicrobial resistance and its drivers: a potential threat to public health. Journal of Global Antimicrobial Resistance 27: 101-111.

Short, F.L. et al., 2021. Benzalkonium chloride antagonises aminoglycoside antibiotics and promotes evolution of resistance. EBioMedicine, 73: 103653.