Policy ForumGlobal Health

Using sewage for surveillance of antimicrobial resistance

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Science  07 Feb 2020:
Vol. 367, Issue 6478, pp. 630-632
DOI: 10.1126/science.aba3432

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Summary

Antimicrobial resistance (AMR), a cross-cutting and increasing threat to global health (13), is a complex problem with multiple and interconnected drivers. Reliable surveillance data that accurately describe and characterize the global occurrence and distribution of AMR are essential for tracking changes in resistance over time, setting national and global priorities, assessing the impacts of interventions, identifying new kinds of resistance, and supporting investigation of (international) outbreaks of resistant pathogens. AMR surveillance data can also inform development of treatment guidelines. Yet it has proven difficult to achieve these objectives on a global scale, and especially in low- and middle-income countries (LMICs), largely because current surveillance systems deliver data that are extremely variable in quality and quantity and highly heterogeneous in terms of which population is sampled (usually a category of hospital patients) and what drug-bug combinations are included (1). Here, we outline a plan for a global AMR surveillance system based on applying next-generation sequencing (NGS) to human sewage that will be especially helpful for community AMR surveillance, which is difficult to achieve in other ways, and will provide an affordable surveillance option in resource-poor settings.

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