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Drain reveals levels of antimicrobial resistance worldwide

Predictions of antimicrobial abundance in all countries and territories of the world. Maps colored according to assumed abundance of antimicrobial from light blue (low abundance) to dark blue (high abundance). Credit: Frank AarestrupAn extensive analysis of sewage collected in 74 cities in 60 countries has given the first comparable global data showing levels and types of antibiotic-resistant bacteria found in healthy people. The National Food Institute, the Technical University of Denmark, led the study, which was conducted by an international research group. In a metagenomics study, researchers surveyed all DNA material in sewage samples and found that the world's countries fall within two groups according to antimicrobial resistance. North America, Western Europe, Australia and New Zealand generally have the lowest levels of antimicrobial resistance, while Asia, Africa, and South America have the highest levels. Brazil, India and Vietnam have the greatest diversity in resistance genes, while Australia and New Zealand have the lowest. Decontamination and health closely related to antimicrobial resistance According to the researchers, the use of antimicrobials explains a minor proportion of the prevalence of antimicrobial resistance in the various countries. Therefore, the researchers have searched for other factors that may be drivers or indicators of the presence of resistant bacteria. In this work, they have used several extensive data sets from the World Bank that involve the countries' health status and stage of development. The researchers' work shows that most variables associated with the prevalence of antimicrobial resistance in one country are related to sanitary conditions in…



Predictions of antimicrobial abundance in all countries and territories of the world. Maps colored according to assumed abundance of antimicrobial from light blue (low abundance) to dark blue (high abundance). Credit: Frank Aarestrup

An extensive analysis of sewage collected in 74 cities in 60 countries has given the first comparable global data showing levels and types of antibiotic-resistant bacteria found in healthy people. The National Food Institute, the Technical University of Denmark, led the study, which was conducted by an international research group.

In a metagenomics study, researchers surveyed all DNA material in sewage samples and found that the world’s countries fall within two groups according to antimicrobial resistance. North America, Western Europe, Australia and New Zealand generally have the lowest levels of antimicrobial resistance, while Asia, Africa, and South America have the highest levels.

Brazil, India and Vietnam have the greatest diversity in resistance genes, while Australia and New Zealand have the lowest.

Decontamination and health closely related to antimicrobial resistance

According to the researchers, the use of antimicrobials explains a minor proportion of the prevalence of antimicrobial resistance in the various countries. Therefore, the researchers have searched for other factors that may be drivers or indicators of the presence of resistant bacteria. In this work, they have used several extensive data sets from the World Bank that involve the countries’ health status and stage of development.

The researchers’ work shows that most variables associated with the prevalence of antimicrobial resistance in one country are related to sanitary conditions in the country and the general state of health of the population. “In the fight against antimicrobial resistance, our findings indicate that it would be a very effective strategy for coordinated efforts to improve sanitary conditions in countries with high levels of antimicrobial resistance,” Professor Frank Aarestrup of the National Food Institute and Head of the Study says.



Sewage samples collected in Sakasaka, Tamale, Northern Region, Ghana. Credit: Courage Kosi Setsoafia Saba, University of Development Studies, Ghana.

With the same data from the World Bank, researchers also predicted the levels of antimicrobial resistance in 259 countries / territories and have developed a world map of resistance in healthy populations. According to their estimates, the Netherlands, New Zealand and Sweden have the lowest levels of resistance, while Tanzania, Vietnam and Nigeria have the highest levels. According to estimates, Denmark has the sixth lowest level of antimicrobial resistance.

Reusable Data

In contrast to data from traditional assay methods, raw data from metagenomic studies can be reused to investigate other problems. The researchers from the sewage project use data from the survey to analyze the presence of other pathogenic microorganisms in the wastewater.

When more resistance gene occurs in the future, the researchers will also be able to analyze publicly available raw material data from metagenomic studies to quickly detect how these genes have emerged and spread.

A step closer to a global monitoring system

The researchers will use the experience of the project to fulfill their overall ambition to develop a worldwide monitoring system that can continuously monitor the occurrence and spread of disease-causing microorganisms and antimicrobial resistance.

“Analysis of wastewater can quickly and relatively cheaply show exactly which bacteria present in an area and collect and analyze sewage t require ethical approval, since the material cannot be traced back to individuals. Both parameters contribute to creating a monitoring system we a sewage is a viable alternative – even in developing countries, says Professor Frank Aarestrup.

The researchers’ ambition is to develop a system that makes it possible to exchange and interpret information in real time, as such it would be possible to use the global monitoring data, .ex managing diseases that threaten to spread beyond the borders of the country and develop into pandemics such as Ebola, measles, polio or cholera.

The study is published in Nature Communications entitled “Global Monitoring of Antimicrobial Resistance based on metagenomic analyzes of urban waste water. “


Explore further:
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More information:
Nature Communications (2019). DOI: 10, 1038 / 41467-019-08853-3

Journal reference:
nature Communications

Provided by:
Technical University of Denmark

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