# The Contribution of Wastewater to the Transmission of Antimicrobial Resistance in the Environment: Implications of Mass Gathering Settings

Review · Nour Fouz, Krisna Nur Andriana Pangesti, Muhammad Yasir, Abdulrahman L. Al‐Malki, Esam I. Azhar, Grant A. Hill-Cawthorne, Moataz Abd El Ghany

- Archive id: doi:10.3390/tropicalmed5010033
- Published: 2020-02-25
- Venue: Tropical Medicine and Infectious Disease
- DOI: https://doi.org/10.3390/tropicalmed5010033
- PMID: 32106595
- Citations: 206
- Source URL: https://doi.org/10.3390/tropicalmed5010033
- PDF: https://www.mdpi.com/2414-6366/5/1/33/pdf?version=1584885114
- Provenance: openalex

## Abstract

Antimicrobial resistance (AMR) is the major issue posing a serious global health threat. Low- and middle-income countries are likely to be the most affected, both in terms of impact on public health and economic burden. Recent studies highlighted the role of resistance networks on the transmission of AMR organisms, with this network being driven by complex interactions between clinical (e.g., human health, animal husbandry and veterinary medicine) and other components, including environmental factors (e.g., persistence of AMR in wastewater). Many studies have highlighted the role of wastewater as a significant environmental reservoir of AMR as it represents an ideal environment for AMR bacteria (ARB) and antimicrobial resistant genes (ARGs) to persist. Although the treatment process can help in removing or reducing the ARB load, it has limited impact on ARGs. ARGs are not degradable; therefore, they can be spread among microbial communities in the environment through horizontal gene transfer, which is the main resistance mechanism in most Gram-negative bacteria. Here we analysed the recent literature to highlight the contribution of wastewater to the emergence, persistence and transmission of AMR under different settings, particularly those associated with mass gathering events (e.g., Hajj and Kumbh Mela).

_Abstract reproduced under CC-BY (publisher license, via OpenAlex)._

Topics: [Infectious Disease, Vaccines & Antimicrobial Resistance](https://space-kitty.com/topics/infectious-disease-amr)

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