Working Title: Socio-spatial variation of antibiotic resistance in an urban sewershed in the Ruhr Metropolis, Germany

Research Countries: Germany

Research Themes: Antimicrobial resistance (AMR); Water, sanitation and hygiene (WASH); Urban health; Social determinants of health; Spatial analysis; Global health

Abstract:

Antimicrobial resistance (AMR) bears the risk of potentially surpassing many communicable and non-communicable diseases by 2050 in terms of attributable deaths (O’Neill 2016). Within AMR, especially antibiotic resistance (ABR) receives a lot of research attention.

Inadequate and excessive use of antibiotics in humans, animals, and plants has been identified among the key drivers of ABR, accelerating this otherwise natural process. Due to their severe adverse consequences, particularly infections with multidrug-resistant bacteria in human health care and community settings constitute a major public health challenge (Nordmann 2013; Giske et al. 2008). Multidrug-resistant bacteria can be spread in many ways whereby the environment occupies a pivotal role. In particular wastewater has been identified as a major source of antibiotic resistance (ABR) elements (Berendonk et al. 2015; Berkner et al. 2014).
Current approaches often investigate the inlet and outlet of wastewater treatment plants thereby examining their treatment performance in regard to multidrug-resistant bacteria. This study will follow a different approach by shifting the focus away from end-of-pipe approaches towards the urban sewershed, thereby trying to identify the association between population characteristics and the occurrence of multidrug-resistant bacteria in wastewater.

At the core of this study is the identification of so-called “socio-spatial” hotspots of antibiotic use in the human outpatient sector and potential associations with the occurrence of extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli in the wastewater system of Dortmund, Ruhr Metropolis, Germany. The social determinants of health will provide a starting point for the investigation of this crucial system component. Monthly wastewater samples over a whole year will be accompanied by a quantitative survey in the general population about antibiotic use, which, in turn, will be prepared and supported by a systematic literature review on determinants of antibiotic use in the community. Eventually, this small-scale analysis allows for the characterization of the urban sewershed in regard to antibiotic use in the community and the associated discharge of multidrug-resistant bacteria.

Supervisor(s):

Prof. Dr. Mariele Evers (GIUB)

Prof. Dr. Thomas Kistemann (IHPH)

Publications:

1. Schmiege, D., Evers, M., Kistemann, T. & Falkenberg, T. (2020) 'What drives antibiotic use in the community? A systematic review of determinants in the human outpatient sector', International Journal of Hygiene and Environmental Health 226: 113497. https://doi.org/10.1016/j.ijheh.2020.113497