London Calling 2023: Antimicrobial wastewater epidemiology in low-resource communities

Antimicrobial resistance (AMR) is an emerging public health threat that disproportionately affects rural areas and low-to-middle-income countries. Environmental pressures, such as overuse and over-reliance on clinically important antimicrobials, has led to an annual increase in multi-AMR pathogens. We developed a wastewater-based surveillance method to identify circulating AMR biomarkers in underserved areas that currently lack comprehensive AMR surveillance. This method leverages new methods developed during the SARS-CoV-2 pandemic, which comprise simple-yet-effective genomic extraction/analysis techniques without the use of conventional laboratory space. Specifically, we developed workflows that have been implemented inside wastewater treatment plants and inside of a cargo van-based laboratory, thereby demonstrating a “decentralized” model for environmental AMR testing. Using this model, we are able to concentrate wastewater on site and begin sequencing data analysis within five hours of collection from clinically relevant sites in Lexington, Kentucky.