A one health approach for monitoring antimicrobial resistance: developing a national freshwater pilot effort

Authors: FRANKLIN, ALISON - Environmental Protection Agency (EPA); WELLER, DANIEL - Centers For Disease Control And Prevention (CDC) - United States; Durso, Lisa; BAGLEY, MARK - Environmental Protection Agency (EPA); DAVIS, BENJAMIN - Environmental Protection Agency (EPA); Frye, Jonathan; GRIM, CHRISTOPHER - Us Food & Drug Administration (FDA); IBEKWE, ABASIOFIOK - Us Environmental Protection Agency (EPA); JAHNE, MICHAEL - Environmental Protection Agency (EPA); KEELY, SCOTT - Environmental Protection Agency (EPA); KRAFT, AUTUMN - Oak Ridge Institute For Science And Education (ORISE); MCCONN, BETTY - Oak Ridge Institute For Science And Education (ORISE); MITCHELL, RICHARD - Environmental Protection Agency (EPA); OTTENSEN, ANDREA - Us Food & Drug Administration (FDA); Sharma, Manan; STRAIN, ERROL - Us Food & Drug Administration (FDA); TADESSE, DANIEL - Us Food & Drug Administration (FDA); TATE, HEATHER - Us Food & Drug Administration (FDA); Wells, James - Jim; Williams, Clinton; Cook, Kimberly - Kim; KABERA, CLAUDINE - Us Food & Drug Administration (FDA); MCDERMOTT, PATRICK - Us Food & Drug Administration (FDA); GARLAND, JAY - Environmental Protection Agency (EPA)

Submitted to: Frontiers in Water
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 3/29/2024
Publication Date: 5/16/2024
Citation: Franklin, A.M., Weller, D.L., Durso, L.M., Bagley, M., Davis, B.C., Frye, J.G., Grim, C., Ibekwe, A.M., Jahne, M., Keely, S.P., Kraft, A.L., McConn, B.R., Mitchell, R., Ottensen, A., Sharma, M., Strain, E., Tadesse, D., Tate, H., Wells, J., Williams, C.F., Cook, K.L., Kabera, C., Mcdermott, P., Garland, J. 2024. A one health approach for monitoring antimicrobial resistance: developing a national freshwater pilot effort. Frontiers in Water. 6. Article 1359109. https://doi.org/10.3389/frwa.2024.1359109.
DOI: https://doi.org/10.3389/frwa.2024.1359109

Interpretive Summary: Antimicrobial resistance is a critical problem that limits our ability to fight infectious disease, resulting in longer illnesses, or even death where once a patient might have survived. Human health, animal health, and environmental health professionals across the globe are partnering to understand the connections between antibiotic resistant bacteria and their genes in the environment, and antibiotic resistant infections in humans, their pets, and food animals. The National Antimicrobial Resistance Monitoring System (NARMS) led by the Food and Drug Administration along with the Centers for Disease Control and U.S. Department of Agriculture has monitored antimicrobial resistant bacteria (ARB) in retail meats, humans, and food animals since the mid 1990’s. However little is known about antibiotic resistance from the environment. This paper reports on a pilot effort to add an environmental component to the current NARMS efforts focused on monitoring surface waters. The effort was divided into five areas: (i) defining objectives and questions, (ii) designing study/sampling design, (iii) selecting AMR indicators, (iv) establishing analytical methods, and (v) developing data management/analytics/metadata plans. For each of these areas, the consensus among the scientific community and literature was reviewed and carefully considered prior to the development of this environmental monitoring program. The data produced from this effort will help develop robust surface water monitoring programs with the goal of assessing risks associated with AMR pathogens in surface water, provide a comprehensive picture of how resistant strains are related spatially and temporally within a watershed, and help assess how anthropogenic drivers and intervention strategies impact the transmission of AMR within human, animal, plants, and environmental systems.

Technical Abstract: Antimicrobial resistance (AMR) is a world-wide public health threat that is projected to lead to 10 million annual deaths globally by 2050. The AMR public health issue has led to the development of action plans to combat AMR, including improved antimicrobial stewardship, development of new antimicrobials, and advanced monitoring. The National Antimicrobial Resistance Monitoring System (NARMS) led by the United States (U.S) Food and Drug Administration along with the U.S. Centers for Disease Control and U.S. Department of Agriculture has monitored antimicrobial resistant bacteria in retail meats, humans, and food animals since the mid 1990’s. NARMS is currently exploring an integrated One Health monitoring model recognizing that human, animal, plant, and environmental systems are linked to public health. Since 2020, the U.S. Environmental Protection Agency has led an interagency NARMS environmental working group (EWG) to implement a surface water AMR monitoring program (SWAM) at watershed and national scales. The NARMS EWG divided the development of the environmental monitoring effort into five areas: (i) defining objectives and questions, (ii) designing study/sampling design, (iii) selecting AMR indicators, (iv) establishing analytical methods, and (v) developing data management/analytics/metadata plans. For each of these areas, the consensus among the scientific community and literature was reviewed and carefully considered prior to the development of this environmental monitoring program. The data produced from the SWAM effort will help develop robust surface water monitoring programs with the goal of assessing public health risks associated with AMR pathogens in surface water (e.g., recreational water exposures), provide a comprehensive picture of how resistant strains are related spatially and temporally within a watershed, and help assess how anthropogenic drivers and intervention strategies impact the transmission of AMR within human, animal, and environmental systems.