Antimicrobial Resistance in the Environment And its relevance to - - PowerPoint PPT Presentation

Antimicrobial Resistance in the Environment

And its relevance to contaminated land practitioners

Lucy Bethell

What is AMR and why is it relevant? AMR in the Environment Source – Pathway – Receptor approach Relevance to contaminated land practitioners

1 2 3 4

Agenda

What is AMR?

“At least 10million people could die every year if we don’t get on top of this” “It could kill us before climate change does.”

Prof Dame Sally Davies

UK Special Envoy on Antimicrobial Resistance Former Chief Medical Officer (CMO) for England and Chief Medical Adviser to the UK government

Antimicrobial Resistance in the Environment Mott MacDonald 13 May 2020

What is AMR?

AMR is viewed as an emerging contaminant

1

Microorganisms are small, living organisms that share the world with

• us. This includes

bacteria, viruses, and fungi

2

Antimicrobials are used to kill microorganisms when they create problems for

• us. Examples include

antibiotics, antivirals, and antifungal agents

3

AMR is when microorganisms evolve (through a process of natural selection) to no longer respond to antimicrobial agents. Antibiotic resistance is a sub-set of AMR.

Antimicrobial Resistance in the Environment Mott MacDonald 13 May 2020

How does AMR occur?

Resistance arises through one of three mechanisms:

1

Natural resistance in certain types of bacteria (inherent resistance)

2

Genetic mutation to protect themselves

Genetic mutation occurs via exposure to sub lethal doses of antibiotics/ antifungals/ antivirals/ antiparasitic and their residues

• r other drivers such as metals
• r biocides

3

One species acquiring resistance from another known as Horizontal Gene Transfer (HGT)

Antimicrobial Resistance in the Environment Mott MacDonald 13 May 2020

Selective pressure

And just to amplify the issue…..

Antibiotics increase selective pressure in bacterial populations, causing vulnerable bacteria to die; this increases the percentage

• f resistant bacteria which

continue growing.

Center for Disease Control and Prevention - Antibiotic resistance threats in the United States, 2013

Antimicrobial Resistance in the Environment Mott MacDonald 13 May 2020

Food production Pharmaceutical production Health facilities Livelihoods Water, sanitation and hygiene Site safety and staff welfare Environment Global transportation Economics Education

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Why is it relevant?

Antimicrobial resistance (AMR) is a recognised global threat It is estimated that the economic cost of AMR through lost global production will be US$100 trillion between now and 2050. Direct and indirect impacts will disproportionately affect low and middle- income countries.(Fleming Fund 2019)

AMR in the Environment

Antimicrobial Resistance in the Environment Mott MacDonald 13 May 2020

The Role of the Environment and AMR

Department of Health, Antimicrobial Resistance (AMR) Systems Map, 2014

Source- Pathway- Receptor Study

BRAND+-

BRAND BRAND

Drivers Source Pathway Receptors

Drivers of AMR

There are four main drivers of AMR:

• Antimicrobials and their residues (there are four

subclasses): − Antibiotics − Antifungals − Antivirals − Antiparasitics

• Metals
• Biocides
• Antimicrobial resistant genes

Sources

• Human waste

− Human waste can carry AMR pathogens and up to 80% of consumed antibiotics are excreted through urine and faeces

• Animal waste

− According to The State of the World’s Antibiotics 2015, two- thirds (65,000 tonnes) of all antibiotics produced each year are used in animal husbandry

• Aquaculture

− It has been estimated that approximately 26,300 tonnes of antibiotics are discharged into the Mekong Delta every year

• Agricultural crops

− From the use of pesticides, fertilisers (including manure and biosolids)

• Antimicrobial manufacturing waste

− Antimicrobials are not listed in the Dangerous Substances Directive so are not routinely tested for.

Pathways

• Municipal waste water
• Manure and sewage sludge applied to land
• Aquaculture contaminated waters
• Crop spraying
• Airborne particles/ bioaerosols

Receptors

We considered micro-organism populations within:

• Groundwater
• Surface waters
• Food products
• Ecosystems

However, humans are the ultimate receptor

Antimicrobial Resistance in the Environment Mott MacDonald 13 May 2020

A simplified Source-Pathway-Receptor model

Key pollutant linkages to receptors

Moderate – high significance

• Discharge of untreated waste water from human

waste

• Land application of animal waste
• Direct discharge of manufacturing waste liquid

effluent

Moderate significance

• Direct discharge of treated water from human waste

water treatment

• Irrigation/ direct discharge/ runoff from greywater/

reclaimed water systems

• Runoff from manure/ livestock

Relevance to contaminated land practitioners

How does this apply to contaminated land practitioners

Metals as drivers

• Metals are a key driver of AMR.
• Heavy metals such as Zn, Cu, Mn, Ni, Cr and Fe in high enough

concentrations act as antimicrobials.

• The accumulation of other heavy metals with a non-biological

role such as Pb and Cd may cause mutagenesis.

• The toxicity of heavy metals in the environment is strongly

dependant on conditions including pH, organic matter and redox, and therefore bioavailability, of the metal ions.

• Given that heavy metals do not degrade within the environment,

not only do selective pressures persist longer than pharmaceutical and clinical compounds but due to industrial and urban pollution the scale of the selection pressure is far more extensive than any other driving agent.

Antimicrobial Resistance in the Environment Mott MacDonald 13 May 2020

How does this apply to contaminated land practitioners

Metals in sediments – the issues

1

Aquatic sediments are a considerable reservoir of AMR resistant micro-

• rganisms.

2

Microorganisms within aquatic sediments are exposed to a vast range of continually changing conditions due to annual cycles in water chemistry within river systems.

3

Anthropogenic pollution into watercourses can lead to rapidly alternating conditions which may result in a switching of absorption and desorption reactions between metals and aquatic sediment.

4

Sediments may ‘store’ metals and nutrients through sorption on to the surface of sand and

• rganic particles for

significant amounts

• f time, until

destabilising due to changing water chemistry results in a mass release

5

Metals do not degrade and are not easily mobilised. Indigenous microorganisms persist over extremely long time scales and interact with metal contaminants in the sediments promoting HGT.

Antimicrobial Resistance in the Environment Mott MacDonald 13 May 2020

How does this apply to contaminated land practitioners

Metals in sediments and soils – the opportunities

Opportunities:

• Target and integrate AMR with regards to remediation of polluted legacy sediments/

soils

• Target and integrate management of industrial waste entering the water

environment (permitting, monitoring etc) How:

• Modifying common practice within preliminary risk assessments and desk studies
• f projects to consider AMR risks and raising them to all Stakeholders
• Use AMR in options appraisal for Remediation Strategies
• Consideration of the applicable technologies
• Ensure we are not underestimating the significance of metals in our risk

assessments

• By making AMR a key factor when assessing the suitability of projects such as

discharge permit locations, planning applications, abstractions from or in proximity to watercourses or contaminated land.

How to tackle AMR

1

Antibiotics & antifungals

Limit clinically important drugs to human use

3

Antibiotic development

New drug development is required

5

Regulation & monitoring

EU, UK and worldwide regulation

2

Broad Spectrum antibiotics

Reduce and keep for human use

4

Wastewater treatment

Greater and better treatment globally

6

Research

To close gaps in knowledge

Antimicrobial Resistance in the Environment Mott MacDonald 13 May 2020

Conclusions

• AMR is a long term battle – the actions we take now

will only be effective in the longer term

• We all have a role to play both personally and

professionally

• We need a holistic approach from all sectors and

action from governments globally

• Our next studies are to look at fate and transport of

AMR within the environment based on available literature data

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Antimicrobial Resistance in the Environment Mott MacDonald 13 May 2020

Credits

− Bryony Osbourne, Aidan Foley, John Prytherch, Emma Stanley & Sarah Dobson (Mott MacDonald) − Mark Sinton (Environment Agency) − Mark Craig (Severn Trent Water) − Dr Andrew Singer (Centre for Ecology and Hydrogeology) − Professor William Gaze (University of Exeter Medical School) − Professor David Graham (Newcastle University School of Engineering)

Antimicrobial Resistance in the Environment Mott MacDonald 13 May 2020

References

− Ben, Y., Fu, C., Hu, M., Liu, L., Wong, M. H., & Zheng, C. (2019). Human health risk assessment of antibiotic resistance associated with antibiotic residues in the environment: a review. Environmental Research, 483-493. − Centre for Disease Control and Prevention (2013)/ Antibiotic resistance threats in the United States. − Department of Health (2014) Antimicrobial Resistance (AMR) Systems Map. − Food and Agriculture Organization of the United Nations. (2016). Drivers, dynamics and epidemiology of antimicrobial resistance in animal production. . − Gelband, H., Miller-Petrie, M., Pant, S., Gandra, S., Levinson, J., Barter, D., & al., e. (2015). The State of the World's Antibiotics. Washington, DC: Centre for Disease Dynamics, Economics and Policy. − https://www.flemingfund.org/wp-content/uploads/LP1_AMR_A4Screen_FinalSignOff_Jan2017.pdf − Khan, R., & Thulin, J. (1991). Influence of pollution on parasites of aquatic animals. Advances in parasitology, 201-238 − Laxminarayan, R., Duse, A., Wattal, C., Zaidi, A., Wertheim, H., Sumpradit, N., . . . Greko, C. (2013). Antibiotic resistance- the need for global solutions. Lancet Infect Dis, 13(12). − Nguyen Dang Giang, C., & al, e. (2015). Occurrence and Dissipation of the Antibiotics sulfamethoxazole, sulfadiazine, trimethoprim, and enrofloxacin in the Mekong Delta, Vietnam. PLOS ONE , 10(7). − Pan, M., & Chu, L. (2016). Adsorption and degradation of five selected antibiotics in agricultural soil. Science of the Total Environment, 48-56. − Rodgers, K., McLellan, I., Peshkur, T., Williams, R., Tonner, R., Hursthouse, A. S., ... & Henriquez, F. L. (2019). Can the legacy of industrial pollution influence antimicrobial resistance in estuarine sediments?. Environmental Chemistry Letters, 17(2), 595-607. − Seiler, C., & Berendonk, T. U. (2012). Heavy metal driven co-selection of antibiotic resistance in soil and water bodies impacted by agriculture and aquaculture. Frontiers in microbiology, 3, 399. − Singer, A. C., Shaw, H., Rhodes, V., & Alwyn, H. (2016). Review of Antimicrobial Resistance in the Environment and its Relevance to Environmental Regulators . Frontiers in Microbiology, 7:1728. − Smith, T. C., Gebreyes, W. A., Abley, M. J., Harper, A. L., Forshey, B. M., & Male, M. J. (2013). Methicillin-resistant Staphylococcus aureus in pigs and farm workers on conventional and antibiotic-free swine farms in the USA. PLoS ONE, 8:e63704. − Su, J., Wei, B., Ou-Yang, W., Huang, F., Zhao, Y., Xu, H., & Zhu, Y. (2015). Antibiotic reistome and its association with bacterial communities during sewage sludge composting. Environ. Sci. Technol. , 7356- 7363. − Taso, R. P., & Cho, J. Y. (2016). Veterinary antibiotics in animal waste, its distribution in soil and uptake by plants: a review. . Sci. Total Environ. , 366-376. − UK Science and Innovation Network. (2018). Initiatives for Addressing Antimicrobial Resistance in the Environment: Current Situation and Challenges. Retrieved from Wellcome.ac.uk: https://wellcome.ac.uk/sites/default/files/antimicrobial-resistance-environment-report.pdf −

• UNEP. (2017). Frontiers 2017 Emerging Issues of Envrionmental Concern. Nairobi : United Nations Environment Programme.

− Wellington, E., Boxall, A., Cross, P., Feil, E., Gaze, W., Hawkey, P., . . . Thomas, C. (2013). The role of the natural environment in the emergence of antibiotic resistance in Gram-negative bacteria. The Lancet Infectious Diseases, 155-165.

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