Antimicrobial Resistance and Environmental Health: A Water Stewardship Framework for Global and National Action

Abstract

Antimicrobial resistance (AMR) is a global health crisis that affects all life on Earth. In 2015, the World Health Organization developed guidance to combat AMR in accordance with a One Health framework considering human, animal, and environment sectors of planetary health. This study reviewed global guidance and 25 National Action Plans to evaluate thematic priorities in One Health AMR approaches using a novel framework that additionally facilitated the identification of water-related stewardship gaps, as water resources are recognized as the primary environmental AMR reservoir and dissemination pathway. This review found that global and national stewardship primarily focuses on mitigating antibiotic use in the human and animal sectors, overlooking environmental drivers, particularly diverse environmental waters. The findings of this study highlight the need to broaden the scope of water-related AMR concerns beyond water, sanitation, and hygiene (WASH) infrastructure for water supply and wastewater treatment, and account for environmental waters in AMR development and dissemination, particularly in low-income countries where half a billion people rely on environmental waters to meet daily needs. Equitably accounting for water environments, supplies, and waste in AMR prevention, mitigation, surveillance, and innovation can significantly enhance the integration of environmental objectives in One Health AMR stewardship.

A Rapid Review of Environmental Health Gaps in Antimicrobial Resistance and Water-Related Research from 1990–2020

“…The review utilized the One Health–One Water AMR Stewardship Framework developed by Kaiser et al [ 10 ] to guide the trend analysis of the included AMR article records. The defined themes ( Table 2 ) [ 3 , 5 , 10 , 16 ] and water type definitions [ 10 ] ( Table 3 ) were used to categorize the current body of AMR-related literature.…”

“…Recent reviews and expert reports, however, have noted that there is limited focus on the role of the environment and natural ecosystems within the current body of literature and policy despite the global One Health push [ 3 , 5 ]. Within the environment sector, water resources, specifically environmental (ambient) source water, are extensively overlooked, preventing an integrated One Health approach [ 3 , 4 , 10 ]. To ensure that AMR risk is holistically and effectively combatted, there is a need for research and stewardship that addresses all AMR risks—from human to animal to environmental reservoirs and dissemination pathways [ 3 , 10 , 11 , 12 , 13 ].…”

“…Within the environment sector, water resources, specifically environmental (ambient) source water, are extensively overlooked, preventing an integrated One Health approach [ 3 , 4 , 10 ]. To ensure that AMR risk is holistically and effectively combatted, there is a need for research and stewardship that addresses all AMR risks—from human to animal to environmental reservoirs and dissemination pathways [ 3 , 10 , 11 , 12 , 13 ].…”

“…This review utilized natural langue processing and term frequency algorithms in a rapid review of AMR literature from 1990–2020 to identify thematic gaps in the One Health integrated approach. A deeper dive into water stewardship gaps was also conducted, as water has been identified as the primary environmental AMR reservoir and dissemination pathway but has thus far received limited attention in One Health achievements [ 3 , 10 ]. Specifically, attention was given to the primary role water plays in relation to human and animal health, whether as a source, supply, or as wastewater.…”

Perspectives on the Ethics of Antibiotic Overuse and on the Implementation of (New) Antibiotics

“…We should not only consider the ethical use of antibiotics in humans and animals but also the ethical (ab)use of our environment [ 35 ]. Our environment may act as a reservoir for antibiotic residues, as well as for the antibiotic resistance genes and pathogens that are generated by the overuse of antibiotics by human and animal farming practices.…”