The surveillance of antimicrobial resistance in wastewater from a one health perspective: A global scoping and temporal review (2014–2024)

Surveillance of antimicrobial resistance (AMR) via a One Health approach must consider the interconnectivity between humans, animals, and the environment. Traditionally, AMR surveillance has relied upon patient-based surveillance in healthcare settings. Wastewater surveillance (WWS) has recently been demonstrated for monitoring AMR to and/or from wastewater treatment plants (WWTPs) which represent a point of intersection between humans, animals and the environment. WWS can be associated with AMR presence and dissemination across entire communities or WWTP catchments, as well as the transfer of AMR to agricultural lands and receiving waters via genes and/or organisms. In this review, the various methodologies used for WWS of AMR and their interpretative significance are identified and discussed, in addition to the potential approaches and outcomes associated with AMR monitoring within WWTPs. A total of 177 reports were identified covering the period 2014 to October 2024, with 136 (76.8 %) appearing after 2019. These recent papers show a distinct emphasis on qPCR and sequencing-based approaches. Surveillance is now global in scope, albeit with a current emphasis on WWTPs in high-income countries. To achieve more effective, global WWS of AMR under a One Health lens, all relevant sectors must understand the principles and capabilities of available methodologies and technologies. Overall, this review seeks to illuminate the diverse interpretations that can be made from WWS of AMR in a One Health context and identify how best to inform future directions regarding AMR monitoring and prevention efforts.