Impact of administered drug use on development of environmental antibiotic resistance genes and risk for human exposure

Wastewater treatment facilities could work as sensors for understanding how human behaviour affects antimicrobial resistance development. Administered drugs, heavy metals and general pollution are all mixed together with human pathogens released through our wastewater system. IMPACT will measure these factors and describe the impact these drugs may have on resistance mechanisms evolving and potential spreading through human driven mechanisms. Norway has a modern system and can assert a high degree of control over the wastewater. Other countries have other challenges, and IMPACT will compare some parameters from Norway to Indonesia, which has a lot of untreated wastewater. We hypothesise that plastic particles, in the form of microplastics, spread biofilms containing resistance genes and could impact aquaculture and recreational areas. These human exposure routes needs to be more understood. IMPACT is addressing that by comparing biofilms formed in Indonesian wastewater systems, recreational areas and coastal aquaculture/fishing sites and compare to Norwegian equivalent sites. The issues of (micro)plastic pollution, metal pollution and antibiotic resistance are complex issues in their own right, when combined, communicating them, not to mention developing solutions for managing them, is unlikely to be straightforward. This project engages an extended peer-community of local stakeholders to developing adequate sustainable solution options through collaborative processes.

Wastewater treatment plants are combining several known antimicrobial resistance drivers in one big melting pot. Residues, but still active antibiotic compounds may act in consort with metal residues and surfaces that promote horisontal gene transfer, namely microplastics. In addition, presence of human bacteria, that could become pathogens given uptake of AMRGs, are prevalent at WWTP due to the nature of sewage. The IMPACT project aims at investigating to what degree this happens under different conditions. We have chosen a comparative approach to a vastly different country, namely Indonesia. Norway and Indonesia obviously face different challenges when it comes to wastewater treatment. Norway have a relative modern wastewater treatment system, bit still faces problems with release of potential damaging agents and potential uptake in the human food chain through maricultures. Indonesia has only a low percentage of treated waste water and also have a different approach to antibiotic usage. In the first phase of the project, we want to decide on relevant sampling sites in Indonesia and Norway that would allow us to sample wastewater over time and describe AMRG drivers and the effects on microbiota. By comparing levels of metals, antibiotic residues and particles for biofilm formation, we will measure the effect on AMRGs presence in the particles and link that to the observed levels of pollutants. Next, we will assess the potential harm to human health by using blue mussels as a model organism for uptake of AMRGs through their filter feeding system. We will also investigate recreational areas, lakes etc. for presence of AMRGs that can be tracked to antibiotic usage.