Superbug threat

Professor David Graham, an environmental engineer who has spent almost 20 years studying the environmental transmission of antibiotic resistance around the world, has contributed to new recommendations for tackling the spread of antibiotic resistance, recently published by the World Health Organisation (WHO).

The spread of SARS-CoV-2, the virus that causes COVID-19, has shown how quickly infectious agents can move around the world.

But the accelerating spread of antibiotic resistance in recent years has led to fears that the growing threat presented by so-called superbugs – bacteria that are resistant to all antibiotics – will compromise our ability to deal with the next major pandemic.

It is now believed there is a significant chance our suite of current antibiotics will fail to combat many new biological infections.

Local “hot-spots” of antibiotic resistance are known to exist around the world, particularly in densely-populated regions with inconsistent sanitation and poor water quality. The new WHO guidance provides a framework for countries to create their own locally-driven national action plans that suit their own particular regional setting.

It takes into account growing evidence, including research by Professor Graham, which suggests that the “superbug problem” will not be solved by prudent antibiotic use alone and that environmental factors may be of equal or greater importance.

 “The only way we are going to win the fight against antibiotic resistance is to understand and act on all of the pathways that lead to it,” explains Professor Graham. “Although the types and drivers of resistance are diverse and will vary by region and country, there are common roots to its spread – excess antibiotic use, pollution, poor water quality, and inadequate hygiene.

 “There is no such thing as a cookie-cutter solution – each country needs to have its own plan for preventing and addressing the spread of antibiotic resistance that considers each country’s particular situation.

“This means rapidly improving waste management, sanitation, and water quality on a global scale – especially in emerging and developing countries – or antibiotic resistance will continue to increase, potentially creating the next pandemic.”

Improved sanitation and hygiene

Work in recent years, often led by Graham and international colleagues, has highlighted that antibiotic-resistant genes can move fast between microbes and through many pathways, even to places where antibiotics functionally are not present, including in polar regions, considered to be among the last ‘pristine’ places on earth.

In an ‘Insights’ article published by The Conversation UK, Professor Graham – who is also a member of the Transmission in Wider Environment Group (TWEG) providing guidance to UK Scientific Advisory Group for Emergencies (SAGE) in relation to the current Covid-19 pandemic – describes how resistance to existing antibiotics continues to increase, which especially impacts places with poor water quality and sanitation.

In the article, Professor Graham and co-author Peter Collignon, Professor of Infectious Diseases and Microbiology, Australian National University, also talk about how the global food trade, pollution and industrial wastes, hospitals, wildlife, and agriculture are all possible pathways or drivers of antibiotic resistance.

“Resistance spread might be fuelled by human faecal contaminated water in one place, while in another, it might be industrial pollution or agricultural activity. So local conditions are key to reducing the spread of antibiotic resistance,” they say in the article.

“Governments throughout the world must work together, and actions against resistance should focus on local needs and plans because each country is different.

 “In some places, actions should clearly focus on healthcare systems, but in many places, promoting cleaner water and safer food may positively impact more people by reducing antibiotic resistance bacteria and genes across the environment, including within and between people and animals.”

The two experts say that once improved sanitation and hygiene – a practice known as WASH – exist at global scales, our reliance on antibiotics will decline due to fairer access to clean water.

 “The spread of antibiotic resistance knows no boundaries, so it is everyone’s problem and all countries have a role in solving the problem,” Professor Graham adds.