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AMR Surveillance Methods that Don’t Stink

Our very own Dr. Chris Connelly, Director of R&D, was asked to participate in a panel on wastewater surveillance at the World Anti-Microbial Resistance Conference 2023. He sat down to recount some of the most important parts of the panel.

• Chris: – Amy Kirby, Ph.D. MPH, Rapid Response Research and Surveillance Branch (Acting Approved), Division of Infectious Disease Readiness and Innovation, CDC
  – Dawn Sievert, Senior Science Advisor, Antimicrobial Resistance Coordination & Strategy, CDC
  – Nichole Brinkman, U.S. Environmental Protection Agency
  – And me! Chris Connelly, Ph.D., Director of R&D here at Streck

• Chris: Everyone poops! That same poop is flushed by humans into our water system and that water can be tested for pathogens in our feces that are associated with disease. Using the wastewater to test for high-risk pathogens in communities, health care facilities and in the environment is an unobtrusive method that gives us a snapshot of diseases in a region of interest at a particular point in time. Consider this like an early defense system used for tracking bad weather. In general, surveillance is an essential tool, and the resulting data can be used to inform policies and infection prevention and control responses. Additionally, it is central to assess the spread of AMR so we can inform and monitor the AMR impact locally and at a global level.

• [Author’s note] Reader, this was in fact under 60 seconds (43 seconds to be exact). To expand a bit, antimicrobial resistance (AMR) occurs when pathogens develop ways to avoid being killed by the antimicrobials that typically target them. This becomes an issue when we run out of antimicrobials that can kill the resistant microbes. A way to prevent this from becoming a life-or-death issue is to try to monitor AMR trends in the population. Wastewater-based epidemiology (WBE) is a tool used by public health professionals to estimate the burden of potentially pathogenic organisms in communities.

• Chris: Healthcare facilities may choose to test wastewater for pathogens present in their facilities. Applied this way, the hospitals can tell if they have effective disinfection strategies and prevent healthcare-associated infections. Additionally, if a particular AMR pathogen is present in a facility, healthcare providers can be aware of the impact it may have on antibiotic treatments, allowing them to choose the most effective treatment strategy. Importantly, clinical labs and local public health agencies must work closely to establish trends in the data and to identify the impact of certain pathogens that are resistant to antimicrobials.
• [Author’s note] Monitoring AMR in hospitals is a critical step in improving antibiotic stewardship – the efforts by clinicians to carefully administer antibiotics that are not only effective, but also appropriate. These efforts depend on accurate diagnosis of the etiological organism, which refines the antibiotic choices and prevents overuse of broad-spectrum drugs.

• Chris: Some pathogens in our environment are zoonotic or can become zoonotic. In other words, the pathogen can move between animals to humans. Measuring agricultural watershed can tell was how much the environment is contributing to AMR risk and if agricultural wastewater is a significant source of transmission.  
• [Author’s note] AMR isn’t just due to overuse of antibiotics in humans. We treat our food-producing animals and crops with antibiotics too! This can become a larger issue if resistant pathogens cause severe infections that lead to widespread loss of plant or animal life or if these pathogens make it into the food production process and onto our dinner plates.

• Chris: The most useful topic we discussed was how to standardize data collection between wastewater collection sites and how to make the data that is reported useful from a clinical and infection control standpoint. In other words, what’s the action plan?  Much of that is still being defined as the CDC works to grow the National Wastewater Surveillance System (they are referring to the branch as “News” (NWSS)). Other organizations such as GLASS (WHO) are also working toward this effort and it’s important that there be collaboration across the board. Additionally, we discussed how to improve AMR surveillance globally so data in low-resource settings can be tracked and utilized to better control the spread of these diseases.
• [Author’s note] NWSS was formed during the COVID-19 pandemic as a way to unite WBE efforts focused on monitoring community wastewater for SARS-CoV-2 and to standardize the data from this surveillance. While the pandemic is still a pressing issue, NWSS continues to concentrate on SARS-CoV-2 but has begun to consider using their WBE network to observe AMR trends in communities. GLASS (Global Antimicrobial Resistance and Use Surveillance System) is an organization formed by the World Health Organization (WHO) that aims to standardize the collection, analysis and sharing of AMR data worldwide. It also emphasize the importance of including epidemiological and population-level data in surveillance approaches and encourage the incorporation of data related to AMR in the food chain and in the environment.