We can use sewage to track the rise of antibiotic-resistant bacteria

The risk is that doctors will opt for what’s known as a broad-spectrum antibiotic—a powerful drug that’s capable of killing many different types of bacteria. These medicines should be a last resort, because bacteria that mutate to resist them could be dangerous—and potentially untreatable.

Wastewater surveillance might reveal which bacteria are spreading in a community and which antibiotics these bugs are vulnerable to. And if scientists notice an increase in genes that confer resistance to a specific antibiotic, they might advise doctors in the area to avoid prescribing that drug, says Kirby.

We can also use water surveillance to monitor how antibiotic-resistance genes might be contaminating the environment. “When we take a course of antibiotics, up to 90% of it is excreted … in feces or urine, and that can end up in our sewers,” says Leonard. And some of this wastewater can make its way into rivers, lakes, and the sea.

This means that not only are we potentially releasing our own AMR bugs into the environment, but we could be encouraging the development of new antibiotic-resistant bacteria in surface water and animal habitats. And these bacteria, or at least their antibiotic-resistance genes, could work their way back into people.

Leonard has been looking for antibiotic resistance in coastal waters around England, Wales, and Northern Ireland. She’s found that people who spend a lot of time in the water—such as surfers—are more likely to have antibiotic-resistant bacteria in their guts. People who bathe in the sea are “three times as likely to carry these resistant bacteria compared to non-bathers,” she says.

It’s not a very nice thought. Especially because even if these bugs don’t make people sick, they can potentially swap genes with other bacteria in a person’s gut. And we don’t really know if harmful, drug-resistant bacteria of some kind will result.

My covid test was negative—I probably have a bog-standard cold. I know I also have billions of bugs in my gut and all over my body, some of which are likely to be resistant to antibiotics. I’m hoping they won’t become any of the dangerous ones.

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The response to covid involved focus, determination, and vast amounts of money. We should use the same approach to tackle antimicrobial resistance, Maryn McKenna wrote in 2021.

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