Transformative Potential of Wastewater Surveillance in Monitoring Antimicrobial Resistance

Valerie Morley, PhD, senior scientist at Ginkgo Bioworks, recently delivered a presentation at the World AMR Congress on the role of wastewater surveillance in monitoring antimicrobial resistance (AMR) across diverse environments, including healthcare settings and agricultural sites. Her talk focused on drawing valuable public health insights from wastewater surveillance for AMR.

She highlighted the benefits of wastewater surveillance for obtaining population-level data, which complements cultured clinical isolates.“Wastewater surveillance is a cost-effective way to get population-level data that can be very targeted. We can look at wastewater coming from a single ward or unit in a hospital, or it can be very broad. We can look at municipal-level wastewater that's coming from an entire community, and importantly, wastewater allows us to get data from the community setting as well as healthcare settings.”

Morley identified technical challenges in associating resistance genes with bacterial organisms and the complexity of interpreting metagenomic data. “One of the big examples that comes to mind for me is that with metagenomic data, we often can't make associations between the resistance genes that we're detecting and the bacterial organisms that they're associated with.”

Morley noted that these challenges stem from limitations in current sequencing approaches but highlighted ongoing efforts to improve accuracy through new methodologies. “That's just kind of a limitation of most types of sequencing approaches, and that's a place where, if we can start to make those associations more accurately, that's really valuable. We're working on that both, there's new approaches coming out that help us to do that. On the wet lab side, they're expensive right now compared to other sequencing methods, and there's also ways to potentially get better at doing that bioinformatically and from a statistical perspective, to make those predictions.”

She underscored the importance of collaborating with end-users to extract meaningful insights and discussed the potential of wastewater surveillance to inform public health strategies. This includes reducing healthcare-associated infections and guiding antimicrobial stewardship through large-scale pilots and data correlation with electronic health records.

“We're really excited about the idea that wastewater surveillance could help hospitals to reduce healthcare-associated infections and to make decisions regarding antimicrobial stewardship. ... This could help to inform when hospitals might want to turn on heightened infection control procedures or more targeted surveillance methods like sequencing or testing swabs, for example.”

In conclusion, Morley highlights wastewater surveillance as a promising tool for monitoring AMR in both healthcare and community settings. While this approach provides valuable population-level data that complements traditional methods, it faces challenges in data interpretation and accuracy. Advances in technology and data integration are expected to enhance its effectiveness, potentially improving infection control and antimicrobial stewardship.