Flushed and Forgotten: Antimicrobial Resistance from Wastewater Perspective

Antimicrobial resistance (AMR) is a major global health threat, reducing the effectiveness of antibacterial treatments. Understanding its spread across different environments is crucial for improving surveillance and guiding policies. Wastewater is an often overlooked but significant contributor to the AMR crisis. It collects bacteria from human, industrial, and agricultural sources, making it both a potential mitigator through treatment and a pathway for antimicrobial-resistant bacteria (ARB) and antimicrobial-resistant genes (ARGs) if not properly managed. The improper handling of wastewater leads to the environmental dissemination of AMR, exacerbating its spread. In many low- and middle-income countries (LMICs), wastewater treatment facilities are either non-existent or incapable of effectively removing ARB, ARGs, and antibiotic residues. The role of wastewater in the development and dissemination of AMR has been significantly underestimated in both scientific research and policy discussions because AMR research has primarily concentrated on clinical settings and agricultural practices. A major challenge in addressing AMR in wastewater systems is the lack of global monitoring and policy frameworks, which limits coordinated efforts. Additionally, wastewater surveillance remains an underutilized tool for tracking AMR trends, missing a critical opportunity for early intervention. Raising awareness about the role of wastewater in AMR is essential for safeguarding global health. Strengthening wastewater treatment practices, implementing standardized monitoring systems, and integrating wastewater-based AMR surveillance into public health strategies can help mitigate the crisis.