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Infectious disease

Global sewage survey maps antimicrobial resistance

Wastewater monitoring could help tackle antimicrobial resistance

by Laura Howes
March 14, 2019 | A version of this story appeared in Volume 97, Issue 11


Map colored according to predicted abundance of antimicrobial resistance, with more in Asia, Africa, and South America.
Credit: Frank Aarestrup
A study of 79 sewage samples generated this map of predicted antimicrobial-gene abundance from low (light blue) to high (dark blue).

Infectious-disease surveillance programs designed to track antimicrobial resistance face practical, ethical, and legal difficulties. Patient data must be anonymized, and it can be difficult to compare data collected from different countries and hospitals. The answer to these challenges, an international team believes, is sewage (Nat. Commun. 2019, DOI: 10.1038/s41467-019-08853-3).

Led by Frank Aarestrup at the Technical University of Denmark, researchers recruited people at 79 sites in 60 countries to the Global Sewage Surveillance Project. Those volunteers collected sewage samples and sent them to Denmark, where researchers looked for genes coding for antimicrobial resistance. They found global and regional differences in antimicrobial-resistance gene diversity and abundance. Microbes in samples from Australia, New Zealand, North America, and western Europe generally had lower levels of antimicrobial resistance; those from Asia, Africa, and South America generally had higher levels. The study found that sanitary conditions and the general health of the population were most strongly associated with a country’s level of antimicrobial resistance. To combat this growing problem, the researchers say, the most effective strategy may be to improve sanitary conditions and monitor progress by continuing to test for resistance genes in sewage.


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