New Weapon in the Fight Against Antimicrobial Resistance

According to the Centers for Disease Control and Prevention (CDC), waterborne illnesses cost the U.S. healthcare system over $3 billion annually and affect more than seven million Americans, though impacts vary widely.

A campus-wide collaboration highlights sewage surveillance as a critical tool in combating waterborne infections like Shigella and Legionella. These diseases are particularly challenging to treat when they exhibit antimicrobial resistance, meaning they can withstand drugs designed to eliminate them.

A recent study published in Nature Water reveals that sewage monitoring provides a more comprehensive and effective method for detecting antimicrobial resistance than individual testing. This approach not only identifies resistance more accurately but also links it to socioeconomic factors, which often play a significant role in the spread of resistance.

Peter Vikesland, Pryor Professor of Engineering in Virginia Tech’s Department of Civil and Environmental Engineering, is the study’s corresponding author. Additional authors include Suraj Gupta (Computer Science), Xiaowei Wu (Statistics), Liqing Zhang (Computer Science), and Amy Pruden (Civil and Environmental Engineering).

The Significance

The Virginia Tech team collaborates with experts across the university, such as Leigh-Anne Krometis (Biological Systems Engineering), Alasdair Cohen, and Julia Gohlke (Population Health Sciences), focusing on rural communities where antibiotic resistance is particularly acute.

Globally, low- to middle-income communities are disproportionately affected by infectious diseases and the challenges of antibiotic resistance. Sewage surveillance could be a groundbreaking approach to address these inequities, providing a community-level view of resistance while highlighting how socioeconomic factors contribute to the issue.

The Study

Supported by the National Science Foundation Research Traineeship, this work aims to combat antibiotic resistance by enhancing sewage surveillance. The initiative is part of a broader effort led by Vikesland and the Fralin Life Sciences Institute to use technology for environmental monitoring of waterborne health threats.

The study analyzed antibiotic resistance gene levels in 234 urban sewage samples from 62 countries and 275 human fecal samples from 23 countries. Socioeconomic data, including governance and health indicators from World Bank databases, were incorporated to explore connections between resistance genes and socioeconomic conditions.

Through machine learning, significant associations were found between the presence of resistance genes and socioeconomic factors. Statistical analysis further confirmed that antibiotic resistance gene variation was smaller within nations than between them.

Overall, the team’s findings demonstrate that sewage surveillance is emerging as a powerful tool in the fight against antibiotic resistance and may help protect vulnerable communities.