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Research article2019Peer reviewedOpen access

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

Hendriksen, Rene S.; Munk, Patrick; Njage, Patrick; van Bunnik, Bram; McNally, Luke; Lukjancenko, Oksana; Roder, Timo; Nieuwenhuijse, David; Pedersen, Susanne Karlsmose; Kjeldgaard, Jette; Kaas, Rolf S.; Clausen, Philip Thomas Lanken Conradsen; Vogt, Josef Korbinian; Leekitcharoenphon, Pimlapas; van de Schans, Milou G. M.; Zuidema, Tina; Husman, Ana Maria de Roda; Rasmussen, Simon; Petersen, Bent; Amid, Clara;
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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 meta-genomic 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.

Published in

Nature Communications
2019, Volume: 10, article number: 1124

      SLU Authors

    • Associated SLU-program

      AMR: Bacteria

      Sustainable Development Goals

      SDG11 Make cities and human settlements inclusive, safe, resilient and sustainable
      SDG3 Ensure healthy lives and promote well-being for all at all ages

      UKÄ Subject classification

      Public Health, Global Health, Social Medicine and Epidemiology

      Publication identifier


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