WHO expert meeting: the role of water in spreading antimicrobial resistance

Will infections again become the number 1 cause of death?

Worldwide, 700,000 people die every year from antibiotic-resistant bacterial infections. There are more and more antibiotic-resistant bacteria and the threat is growing every year: a British government commission report estimates that, if nothing is done, in 2050 10,000,000 people worldwide will die of such infections (O’Neill 2016. Tackling drug resistance globally). This would mean that death from infection would again constitute one of the main causes of death, as was the case before the discovery of antibiotics.

Annual number of deaths worldwide from different causes, including current and forecast deaths due to antimicrobial resistance (AMR)

Spread through the watercycle

Antimicrobial resistance to antibiotics originates in all sorts of sectors, for example, through the (excessive) use of antibiotics in meat production or through the (frequently unnecessary) prescription of antibiotics to people. The watercycle plays a role in the spread of antimicrobial resistance: from the discharge of antibiotic-resistant microorganisms and antibiotic-resistance genes into the aquatic environment, to the transfer of resistance genes in the environment, and the exposure to resistance genes in the aquatic environment (drinking, recreation, irrigation of food crops, aquaculture). Growing urbanisation and livestock production increase the pressure on the aquatic environment: direct or indirect contact with water can increasingly result in exposure to antibiotic resistance. Resistance genes – including some resistant to the latest-generation antibiotics – are detected with increasing frequency in sewage water, surface water and water bottoms. The aquatic environment is therefore possibly becoming not only a reservoir but also a crucible for antimicrobial resistance to antibiotics.

Water sector in a central position for actions

WHO therefore wants more attention to be focused on antimicrobial resistance in water. More knowledge is needed about contamination sources, dissemination routes, presence and behaviour (transport, persistence, transfer), and the exposure and health risks of antimicrobial resistance in water. More knowledge is also needed about the removal of antimicrobial resistance during treatment processes in the watercycle.

In the Netherlands, our drinking water provision includes a considerable number of barriers against antimicrobial resistance, and exposure through drinking water is probably quite limited compared to other routes, such as meat production. But we don’t yet have a great deal of knowledge about this either. Nevertheless, even if exposure via the watercycle, particularly in the Netherlands, is minor, the water sector worldwide does occupy an excellent central position from which to contribute to actions against this problem:

• the water sector is itself a beneficiary of a clean aquatic environment, and is one of the key advocates and stewards of this objective;
• the water sector has possibilities of taking action in the watercycle to help mitigate the spread of resistance genes and the associated health risks.

It is time therefore to develop a water action plan, within the context of the action plans against antibiotic resistance for other sectors [healthcare, livestock production, food].

KWR – WHO collaboration

KWR is a WHO Collaborating Center on Water Quality & Health, and is also one of the test laboratories for the WHO International Scheme to Evaluate Household Water Treatment Technologies, through which WHO aims, via the certification of household water treatment systems, to reduce diarrhoea-related infant mortality in developing countries.

You’ll find more information about antimicrobial resistance to antibiotics on the WHO website; for example, this interview and this flyer.

Gertjan Medema, Chief Science Officer KWR and Bruce Gordon Coordinator of Water, Sanitation, Hygiene and Health van WHO.

Expert meeting WHO at KWR.

35 experts from all over the world came together at KWR to help WHO to make an action plan against dissemination of antibiotic resistance through water.