Water and sanitation: an essential battlefront in the war on antimicrobial resistance
Open accessAbstract
Water and sanitation represent a key battlefront in combatting the spread of antimicrobial resistance (AMR). Basic water sanitation infrastructure is an essential first step towards protecting public health, thereby limiting the spread of pathogens and the need for antibiotics. AMR presents unique human health risks, meriting new risk assessment frameworks specifically adapted to water and sanitation-borne AMR. There are numerous exposure routes to AMR originating from human waste, each of which must be quantified for its relative risk to human health. Wastewater treatment plants play a vital role in centralized collection and treatment of human sewage, but there are numerous unresolved issues in terms of the microbial ecological processes occurring within them and the extent to which they attenuate or amplify AMR. Research is needed to advance understanding of the fate of resistant bacteria and antibiotic resistance genes in various waste management systems, depending on the local constraints and intended reuse applications. World Health Organization and national AMR action plans would benefit from a more holistic 'One Water' understanding. In this article we provide a framework for research, policy, practice and public engagement aimed at limiting the spread of AMR from water and sanitation in low-, medium- and high-income countries.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Almost no studies have evaluated if water and sanitation options more suitable for urban informal settlements in LMICs could reduce the discharge of antimicrobial-resistant bacteria, resistance genes, and antibiotic residues into the environment.
“However, almost no studies have evaluated if water and sanitation options more suitable for urban informal settlements in LMICs could do the same 100,101 .”
From Urban informal settlements as hotspots of antimicrobial resistance and the need to curb environmental transmission. (2020) · cites this paper as [101]
Cites
Antibiotic resistance is ancient
D’Costa, V. M., King, C. E., Kalan, L., Morar, M., Sung, W. W. L., Schwarz, C., Froese, D., Zazula, G., Calmels, F., Debruyne, R., et al. (2011) · Nature · doi:10.1038/nature10388 · Cited by 2,720 · see citing works
Rizzo, L., Manaia, C., Merlin, C., Schwartz, T., Dagot, C., Ploy, M. C., Michael, I., & Fatta-Kassinos, D. (2013) · Science of The Total Environment · doi:10.1016/j.scitotenv.2013.01.032 · Cited by 2,493 · see citing works
Self-citationThe shared antibiotic resistome of soil bacteria and human pathogens
Forsberg, K. J., Reyes, A., Wang, B., Selleck, E. M., Sommer, M. O. A., & Dantas, G. (2012) · Science · doi:10.1126/science.1220761 · Cited by 1,650 · see citing works
Hegstad, K., Langsrud, S., Lunestad, B. T., Scheie, A. A., Sunde, M., & Yazdankhah, S. P. (2010) · Microbial Drug Resistance · doi:10.1089/mdr.2009.0120 · Cited by 396 · cited 1× · see citing works
“In addition,WWmay contain other compounds such as metals and/or biocides, including disinfectants such as quaternary ammonium compounds that have been implicated in ARG selection via co- or cross-resistance (Wales and Davies 2015; Hegstad et al. 2010).”
Background
Flagged first, then by citations
Cited by
Sorted by citations
Prüss-Ustün, A., Wolf, J., Bartram, J., Clasen, T., Cumming, O., Freeman, M. C., Gordon, B., Hunter, P. R., Medlicott, K., & Johnston, R. (2019) · International Journal of Hygiene and Environmental Health · doi:10.1016/j.ijheh.2019.05.004 · Cited by 1,308 · see citing works
Rizzo, L., Gernjak, W., Krzeminski, P., Malato, S., McArdell, C. S., Perez, J. A. S., Schaar, H., & Fatta-Kassinos, D. (2020) · Science of The Total Environment · doi:10.1016/j.scitotenv.2019.136312 · Cited by 308 · see citing works
Nadimpalli, M. L., Marks, S. J., Montealegre, M. C., Gilman, R. H., Pajuelo, M. J., Saito, M., Tsukayama, P., Njenga, S. M., Kiiru, J., Swarthout, J., et al. (2020) · Nature microbiology · doi:10.1038/s41564-020-0722-0 · Cited by 223 · see citing works
- Authors
- Bürgmann, H., Frigon, D., H Gaze, W., M Manaia, C., Pruden, A., Singer, A. C., F Smets, B., & Zhang, T.
- Affiliations
- Swiss Federal Institute of Aquatic Science and Technology (CH)
- McGill University (CA)
- European Center for Environment and Human Health, University of Exeter Medical School, Truro, TR1 3HD, UK
- Universidade Católica Portuguesa, CBFQ- Centro de Biotecnologia e Química Fina - Laboratório Associado, Escola Superior de Biotecnologia, Rua Arquiteto Robão Vital, Apartado 2511, 4202-401 Porto, Portugal
- Virginia Tech (US)
- UK Centre for Ecology & Hydrology (GB)
- Department of Environmental Engineering, Technical University of Denmark, Miljøvej, DK 2800 Kgs., Lyngby, Denmark
- University of Hong Kong (HK)
- Corresponding author
- Pruden, Amy
- Venue
- FEMS Microbiology Ecology
- Publisher
- Oxford University Press (OUP)
- Published
- 2018-06-05
- Volume
- 94
- Issue
- 9
- ISSN
- 0168-6496 (ISSN-L)
- 1574-6941
- OpenAlex
- W2807151339
- Cited by
- 182
- References
- 4
- Citations by year
- 2026: 11 · 2025: 17 · 2024: 36 · 2023: 22 · 2022: 25 · 2021: 38 · 2020: 17 · 2019: 13 · 2018: 3
- FWCI
- 6.66
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- FEMS Microbiology Ecology (publishedVersion)
- PubMed (publishedVersion)
- NERC Open Research Archive (Natural Environment Research Council) (acceptedVersion)
- DORA Eawag (Swiss Federal Institute of Aquatic Science and Technology (Eawag)) (submittedVersion, other-oa)
- Technical University of Denmark, DTU Orbit (Technical University of Denmark, DTU) (submittedVersion, other-oa)
- Portuguese National Funding Agency for Science, Research and Technology (RCAAP Project by FCT) (submittedVersion)
- Funders
- National Science Foundation (1545756)
- U.S. Department of Agriculture (2017-68003-26501, 2014-05280)
- National Institute of Food and Agriculture (2014‐05280, 2017-68003-26501)
- Natural Environment Research Council (NE/N019687/1, NE/M011259/1, NE/N019717/1)
- Topics
- Physical Sciences › Environmental Science › Pollution › Pharmaceutical and Antibiotic Environmental Impacts
- Life Sciences › Immunology and Microbiology › Applied Microbiology and Biotechnology › Antibiotic Use and Resistance
- Physical Sciences › Environmental Science › Waste Management and Disposal › Wastewater Treatment and Reuse
- Keywords
- antimicrobial resistance, water and sanitation, wastewater treatment plants, antibiotic resistance genes, drug-resistant bacteria, human waste, exposure routes, water reuse, low- and middle-income countries
- MeSH terms
- Anti-Bacterial Agents, Bacteria, Humans, Sewage, Water Microbiology, Water Purification, Drug Resistance, Bacterial
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
