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EU-WISH ProjectEU-WISH Project

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Wastewater surveillance of antimicrobial resistance across Europe

| Result

Objectives, methods and state of implementation revealed in the EU-WISH Joint Action mapping.

EU-WISH (EU-Wastewater Integrated Surveillance for Public Health) is a Joint Action under the EU4Health programme, which supports the policy priority of strengthening the European Union’s capacity to prevent, prepare for and respond rapidly to serious cross-border health treats. The objective of EU-WISH is to develop wastewater surveillance for public health action and thus monitoring of community wastewater influent, i.e. untreated wastewater entering wastewater treatment plants (WWTPs), is a key area of focus.

Antimicrobial resistance (AMR) surveillance from wastewater influents can provide a comprehensive overview of AMR dynamics at the human community level, complementary to existing surveillance from the public health point of view. To cover the environmental aspects of wastewater surveillance, by e.g. effluent monitoring, providing valuable information for managing prevention and control interventions against the spread of AMR, EU-WISH collaborates with another EU Joint Action, EU-JAMRAI2 in further developing and enhancing the environmental component of AMR surveillance strategies in Europe. These activities are timely, given the recent recast of Urban Wastewater Treatment Directive that mandates AMR surveillance in wastewater.

Mapping survey revealed operative AMR WES programs in Europe

During the summer 2024, one of the actions of the EU-WISH consortium was to conduct the T5.1 Mapping Survey aiming to map wastewater surveillance activities at the European level. A part of this survey was dedicated to map the status of wastewater-based surveillance actions for antimicrobial resistance (AMR).

Among the 27 European countries responding to the survey, eleven (41%) reported having an operative Wastewater and Environmental Surveillance (WES) system for AMR in 2024. In the survey, the operative WES system referred to programs implemented either at research level or national public health level, with either limited duration or institutionalized, where data collection is either in exploratory phase or data is reported to key decision-makers.

According to the survey responses, the primary objective of AMR wastewater surveillance systems was the identification of trends of AMR in the human population for many countries, aligning with the broader epidemiological aims of wastewater-based surveillance.

AMR monitoring is conducted by culture-based methods

Within the identified operative AMR WES programs, extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli and carbapenemase-producing Enterobacteriaceae (CPE) were the primary targets for surveillance, typically identified by using culture-based methods. The identification was frequently supplemented with whole genome sequencing (WGS) of isolated bacterial cultures or quantitative PCR (qPCR) approaches for detecting specific antibiotic resistance genes in these organisms.

Detection techniques of ESBL and CPE in WES for AMR.

AMR WES faces challenges in integrating data for public health decisions

The primary challenge reported by participating countries in AMR WES was the translation and integration of results into clinical surveillance and response systems. This aligns with the observation that most AMR WES initiatives were not being utilized as complementary surveillance systems, nor informing public health decision-making in participating countries.
The majority of countries conducted in 2024 AMR WES as research projects with limited duration and with temporary financial support. This observation corresponds with the finding that insufficient funding and lack of financial support to ensure operationalization and sustainability represent major challenges for AMR WES implementation across participating countries.

The survey was conducted within the context of EU-WISH task 5.1 (Mapping wastewater surveillance activity), with valuable support of many EU-WISH participants and key stakeholders from each responding country.

 

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