Monitoring of antimicrobial resistance (AMR) is needed to better protect public health, according to a European Environment Agency (EEA) study published today, which identifies priorities for setting up Europe-wide monitoring of antimicrobial resistance in the aquatic environment.
The monitoring of antimicrobial resistance in surface waters is needed to assess the risks of transmission of resistance to humans, the EEA briefing ‘Antimicrobial resistance in surface waters‘ says. With AMR in the environment now recognised as a key part of the EU’s One Health Action Plan, and new EU rules like the revised Urban Wastewater Treatment Directive requiring monitoring from 2030, countries need to establish monitoring programmes for this newly identified risk in water.
AMR in the environment
Antibiotics and antibiotic-resistant bacteria occur naturally in the environment, but main drivers are from human and veterinary use of antibiotics. Discharges from pharmaceutical industries, urban wastewater and treated sewage sludge, and agricultural manures and waste can spread antibiotic resistance into the environment.
Natural environments can act as reservoirs for resistant microorganisms and drive the development and selection of antibiotic resistance genes. The transfer of these genes between microorganisms is a natural process, though it can be enhanced by human activities, and factors such as pollution and temperature, according to the EEA briefing.
Evidence suggests that antimicrobial resistance in the environment could drive the development and spread of resistance, putting human and animal health at risk.
Monitoring is key
Monitoring for AMR in surface waters would complement monitoring already conducted in other areas like in the food and animal health sectors. The EEA briefing sets out aspects that should be considered to establish robust, Europe-wide environmental AMR monitoring, including clear objectives, harmonised methods and protocols of sampling, robust quality and control procedures, and a centralised data reporting system. This is based on key findings from a EEA network working group pilot study, which involved experts from 14 European countries.
Environmental monitoring can help identify AMR hotspots; assess the spread of AMR and vectors for transmission; inform on trends and emerging genes; track the effectiveness of interventions such as waste management; and strengthen our understanding of AMR-related risks.
EU action
The EU has taken significant actions to address antimicrobial resistance. This includes the so-called One Health approach and its action plan which stresses the role of robust surveillance and monitoring.
EU water-related legislation has also started to address the need for AMR monitoring and reporting. For example, the revised Urban Wastewater Treatment Directive establishes the requirement and methodology for monitoring AMR in urban wastewater. Provisional agreement for revisions to the Water Framework Directive, the Environmental Quality Standards Directive and Groundwater Directive should allow indicators of AMR to be included in surface and groundwater watch lists, and the development of AMR monitoring methods.
Background
Antimicrobial resistance is a top global public health threat, according to the World Health Organization. The health burdens from AMR infections are comparable to major diseases such as HIV and malaria and are potentially far larger. Antimicrobial resistance leads to infections that are getting harder to treat, resulting in prolonged illness, higher medical costs, and increased mortality. Forecasts predict up to 1.9 million deaths attributable to AMR and 8.2 million associated deaths globally by 2050. More than 35,000 people die from antibiotic-resistant infections each year in the EU, Iceland and Norway, a number that has increased in recent years, according to the European Centre for Disease Control (ECDC).
The main drivers of AMR are the overprescription and improper use of antibiotics in healthcare and veterinary settings. Over time, microorganisms develop resistance against antimicrobial compounds. Discharges from hospital and wastewater treatment facilities can also spread antibiotic resistant bacteria (ARB) and/or antibiotic resistance genes (ARGs) into the environment. The environment is therefore increasingly recognised as an important reservoir of AMR, potentially playing a key role in the spread of AMR.
This EEA briefing is based on the pilot study carried by the Eionet Working Group on AMR in surface waters, carried out in 2024 and reported earlier this year.
