Lancet study finds link between antibiotic resistance genes, water and sanitation

Water and sanitation interventions are needed to block transmission of antibiotic resistance genes, antibiotic-resistant bacteria and dissemination of antibiotic residues between humans, animals, environment and the food-supply chain

By Zumbish
Published: Monday 03 July 2023
Photo from representation from iStock

Increased access to improved water and sanitation is associated with lower Antibiotic Resistance Genes (ARG) abundance, a new study published in The Lancet has noted.

The study, which identified 1,589 metagenomes (the sum of genomes of bacteria and fungi in environmental samples) from 26 countries, suggested that the highest burden of antibiotic resistance occurring in low-resource settings was a factor behind ARGs causing deaths. It also said the association of water and sanitation with ARG was stronger in urban-over-rural areas.

The study highlighted many of the most concerning resistance phenotypes (set of observable characteristics or traits of and organism) currently observed in the clinical setting are conferred through ARGs.

Pathogenic bacteria can acquire ARGs from other bacteria through horizontal gene transfer, it said. Horizontal gene transfer is the movement of genetic material between unicellular and / or multicellular organisms.

The researchers also found that low-income and middle-income countries (LMICs) had the highest burden of antibiotic-resistant infections. Some of the most concerning ARGs are believed to have emerged in LMICs, it stated.

However, additional studies were needed to determine if there is a causal relationship between improving water, sanitation and hygiene (WASH) and antibiotic resistance burden. Further metagenomic data from LMICs is also needed, it said.

The abundance of ARGs was highest in (sub-Saharan) Africa, followed by South-East Asia and South and Central America. Total ARGs were also highest in Africa, the study found.

“Inadequate WASH infrastructure and access could exacerbate the spread of resistance. Clean drinking water and flush toilets are nearly universal in most high-income countries (HICs), but availability is variable to non-existent in many LMIC settings,” the study further raised.

Water and sanitation interventions are needed to block the transmission of ARGs, antibiotic-resistant bacteria, and the dissemination of antibiotic residues between humans, animals, the environment, and the food-supply chain.

Erica R Fuhrmeister, Abigail P Harvey, Maya L Nadimpalli, Karin Gallandat, Argaw Ambelu and Benjamin F Arnold, among others authored the study. It received funding from the US National Institute of Allergy and Infectious Diseases (NIAID). 

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