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Global monitoring of antimicrobial resistance based on metagenomics analyses of urban sewage

2019; Nature Portfolio; Volume: 10; Issue: 1 Linguagem: Inglês

10.1038/s41467-019-08853-3

2041-1723

René S. Hendriksen, Patrick Munk, Patrick Murigu Kamau Njage, Bram A. D. van Bunnik, Luke McNally, Oksana Lukjančenko, Timo Röder, David F. Nieuwenhuijse, Susanne Karlsmose Pedersen, Jette Kjeldgaard, Rolf Sommer Kaas, Philip T. L. C. Clausen, Josef Korbinian Vogt, Pimlapas Leekitcharoenphon, M.G.M. van de Schans, T. Zuidema, Ana Maria de Roda Husman, Simon Rasmussen, Bent Petersen, Artan Bego, Catherine A. Rees, Susan Cassar, Kris Coventry, Peter Collignon, Franz Allerberger, Teddie O. Rahube, Guilherme Oliveira, Ivan Ivanov, Yith Vuthy, Thet Sopheak, Christopher K. Yost, Changwen Ke, Huanying Zheng, Li Baisheng, Xiaoyang Jiao, Pilar Donado-Godoy, Kalpy Julien Coulibaly, Matijana Jergović, Jasna Hrenović, Renáta Karpíšková, José E. Villacís, Mengistu Legesse, Tadesse Eguale, Annamari Heikinheimo, Lile Malania, Andreas Nitsche, Annika Brinkmann, Courage Kosi Setsoafia Saba, Béla Kocsis, Norbert Solymosi, Thorunn R. Thorsteinsdottir, A. A. Mohamed Hatha, Masoud Alebouyeh, Dearbháile Morris, Martin Cormican, Louise O’Connor, Jacob Moran‐Gilad, Patricia Alba, Antonio Battisti, Zeinegul Shakenova, Ciira Kiiyukia, Eric Ng’eno, Lul Raka, Jeļena Avsejenko, Aivars Bērziņš, Vadims Bartkevičs, Christian Penny, Heera Rajandas, Sivachandran Parimannan, Malcolm Vella Haber, Pushkar Pal, Gert‐Jan Jeunen, Neil J. Gemmell, Kayode Fashae, Rune Holmstad, Rumina Hasan, Sadia Shakoor, Maria Luz Zamudio Rojas, Dariusz Wasyl, Golubinka Boševska, Mihail Kochubovski, Radu Cojocaru, Amy Gassama, Vladimir Radosavljević, Stefan Wuertz, Rogelio Zuniga-Montanez, Moon Y. F. Tay, Dagmar Gavačová, Katarína Pastuchová, Peter Truska, Marija Trkov, Kerneels Esterhuyse, Karen H. Keddy, Marta Cerdà‐Cuéllar, Sujatha Pathirage, Leif Norrgren, Stefan Örn, D. G. Joakim Larsson, Tanja Van der Heijden, Happiness Kumburu, Bakary Sanneh, Pawou Bidjada, Berthe‐Marie Njanpop‐Lafourcade, Somtinda Christelle Nikiema-Pessinaba, Belkıs Levent, John Scott Meschke, Nicola K. Beck, Chinh Dang Van, Nguyen Do Phuc, Doan Minh Nguyen Tran, Geoffrey Kwenda, Djim-adjim Tabo, Astrid Louise Wester, Sara Cuadros-Orellana, Clara Amid, Guy Cochrane, Thomas Sicheritz‐Pontén, Heike Schmitt, Jorge Raul Matheu Alvarez, Awa Aïdara‐Kane, Sünje Johanna Pamp, Ole Lund, Tine Hald, Mark Woolhouse, Marion Koopmans, Håkan Vigre, Thomas Nordahl Petersen, Frank M. Aarestrup,

Antibiotic Use and Resistance

Antimicrobial resistance (AMR) is a serious threat to global public health, but obtaining representative data on AMR for healthy human populations is difficult. Here, we use metagenomic analysis of untreated sewage to characterize the bacterial resistome from 79 sites in 60 countries. We find systematic differences in abundance and diversity of AMR genes between Europe/North-America/Oceania and Africa/Asia/South-America. Antimicrobial use data and bacterial taxonomy only explains a minor part of the AMR variation that we observe. We find no evidence for cross-selection between antimicrobial classes, or for effect of air travel between sites. However, AMR gene abundance strongly correlates with socio-economic, health and environmental factors, which we use to predict AMR gene abundances in all countries in the world. Our findings suggest that global AMR gene diversity and abundance vary by region, and that improving sanitation and health could potentially limit the global burden of AMR. We propose metagenomic analysis of sewage as an ethically acceptable and economically feasible approach for continuous global surveillance and prediction of AMR.