Urgent need for integrated detection strategies for AMR in water environments

Antimicrobial resistance (AMR) in water environments poses a growing threat to global public health by fostering the spread of resistance genes and limiting the effectiveness of antimicrobial treatments. It also jeopardizes ecological stability, creating challenges in managing the environmental resistome and its potential impact on human and animal health.

A recent review article by researchers from the University of Galway investigated the methods employed to detect AMR in various water environments, with a focus on method capabilities, limitations and implications for public health and environmental safety.

The article titled ‘Antimicrobial resistance detection methods in water environments: A scoping review’ was published Sustainable Microbiology an Applied Microbiology International publication. Lead author of the study Dr Zina Alfahl is a member of Applied Microbiology International’s One Health Advisory Group.

The current state of AMR detection in water environments shows a growing reliance on advanced molecular methods such as polymerase chain reaction (PCR) and metagenomics, valued for their sensitivity and ability to provide comprehensive resistome analysis. The review found that these methods, used in 57% and 27% of studies respectively, are favoured despite their high cost and technical demands.

Traditional culture-dependent methods, while cost-effective and straightforward, are limited in scope, as they cannot detect non-viable resistant organisms and are time-consuming.

Geographic disparities in AMR monitoring efforts

River water is the most commonly studied sample type, with research largely concentrated in the USA, China, and Brazil. However, challenges remain, particularly in making advanced methods more accessible and integrating them with traditional approaches to provide a balanced, practical and cost-effective solution for global AMR surveillance in water environments.

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The article broadens understanding of AMR detection in water environments by highlighting key trends and gaps in current methodologies. It underscores the growing adoption of advanced molecular techniques, such as PCR and metagenomics, which provide a more sensitive and comprehensive analysis of antimicrobial resistance genes compared to traditional culture-dependent methods.

The authors analysed 115 studies, the review clarifies the global research focus, showing that while certain regions like the USA, China, and Brazil lead the way, other parts of the world remain underrepresented, suggesting geographic disparities in AMR monitoring efforts.

Rivers play significant role in disseminating resistance genes

The synthesis of findings also revealed the limitations of current methods, particularly the inability of culture-based techniques to capture non-viable resistant organisms and the resource-intensive nature of molecular approaches. Additionally, it identified the significant role of water environments, especially river systems, in the dissemination of resistance genes, emphasizing their importance as a focal point for surveillance.

Crucially, the review calls attention to the urgent need for integrated detection strategies that combine the precision of molecular tools with the cost-effectiveness of traditional methods. This integrated approach could enable more efficient, accessible, and scalable AMR monitoring. Overall, the review provides a roadmap for future research and policy-making, promoting a more global and holistic understanding of AMR in water environments.

There is a critical need for effective AMR detection methods in water environments to safeguard public health and environmental integrity. Water systems, particularly rivers, act as reservoirs and transmission pathways for AMR genes, posing risks to human and animal populations.

Need for accessible cost effective detection strategies

The findings emphasize the importance of adopting advanced molecular methods like PCR and metagenomics for their ability to detect a broader range of resistance markers, which can inform targeted interventions to mitigate the spread of AMR.

However, the limitations of these techniques, including their high costs and technical complexity, underscore the necessity of developing more accessible, cost-effective and scalable detection strategies.

Enhanced AMR monitoring in water environments can guide global public health policies, improve wastewater management, and support the development of integrated approaches to control AMR. By addressing these challenges, we can better protect ecosystems, preserve antimicrobial efficacy, and reduce the global burden of resistant infections.

The article highlighted that future efforts should focus on:

• Developing cost-effective, user-friendly AMR detection methods to enhance accessibility.
• Establishing integrated approaches combining culture-based, molecular, and metagenomic tools.
• Expanding global monitoring frameworks to include underrepresented regions and water types.
• Investigating the ecological and evolutionary dynamics of AMR in diverse water environments.

The review was led by Dr Zina Alfahl, lecturer in Bacteriology at the School of Medicine at the University of Galway. Additional authors include Dr Louise O’Connor, Ms Niamh Cahill, Ms Alexandra Chueiri, Ms Shaunagh Carolan, Mr Gabriel Darcy and Dr Nadia Hussain.

The article is published in Sustainable Microbiology, an Applied Microbiology International publication.