Groundwater resources as a global reservoir for antimicrobial-resistant bacteria

Antimicrobial resistance represents one of our most significant global health threats, with increasing incidences noted in both clinical and environmental settings. As such, identifying and understanding the sources and pathways for antimicrobial-resistant bacteria (ARB) is critical. The current study presents the first systematic review and pooled analysis of ARB occurrence in global groundwater supplies, which are used as primary drinking water sources by 2.2 billion people worldwide and are recurrently linked to significant outbreaks of infection. Seventy peer-reviewed studies were identified and included; findings reveal that 80.2% ± 29.0 and 57.2% ± 36.8 of aggregated groundwater isolates were resistant to ≥1 and ≥3 antimicrobials, respectively. Where bacteria were present, ARB were identified in 76.9% ± 33.7 of individual wells and springs. Our results leave little doubt that groundwater represents a major global reservoir for ARB, however significant research is required to establish environmental determinants and mechanisms mediating their occurrence.