Kim Sooyeol, Zulli Alessandro, Chan Elana M G, Duong Dorothea, Linfield Rebecca Y, McCormack Caroline, White Bradley J, Wolfe Marlene K, Boehm Alexandria B, Pickering Amy J
Department of Civil and Environmental Engineering, University of California, Berkeley, CA, 94720, USA.
Department of Civil and Environmental Engineering, Stanford University, Stanford, CA, 94305, USA.
medRxiv. 2025 Apr 4:2025.04.02.25325128. doi: 10.1101/2025.04.02.25325128.
Antibiotic resistance is a growing public health threat, with over 2.8 million antibiotic-resistant infections and 35,000 attributable deaths annually in the U.S. This is an underestimate, as it is based on people who seek medical attention. Here, we sought to use wastewater monitoring to assess community-level antibiotic resistance. This study quantifies concentrations of antibiotic resistance genes (ARGs) by digital droplet PCR in wastewater solids obtained from 163 wastewater treatment plants across the United States. We measure 11 ARGs that confer resistance to beta-lactams (), colistin (), tetracycline (), and vancomycin (). The Northeast and South have higher overall ARG concentrations compared to the West and Midwest. We pair these data with national data sets including antibiotic use, social vulnerability, size of animal agriculture operations, density of healthcare facilities, and presence of airports to investigate potential drivers of resistance. We also generate predictive maps of ARG concentrations for every county in the United States. We show social vulnerability indicators (overcrowding, housing burden, and access to health insurance) and indicators of international travel are associated with increased ARG concentrations in wastewater, while antibiotic usage is only weakly positively correlated. Our results provide a national baseline of ARG concentrations and highlight the complexity of factors driving spread of antibiotic resistance.
抗生素耐药性对公众健康构成的威胁日益严重，在美国，每年有超过280万例抗生素耐药性感染病例，3.5万人因此死亡。这只是一个保守估计，因为它仅基于寻求医疗救治的人群。在此，我们试图通过废水监测来评估社区层面的抗生素耐药性。本研究通过数字液滴聚合酶链反应（PCR）对从美国163家污水处理厂采集的废水固体中的抗生素耐药基因（ARG）浓度进行了量化。我们检测了11种赋予对β-内酰胺类、黏菌素、四环素和万古霉素耐药性的ARG。与西部和中西部地区相比，东北部和南部地区的ARG总体浓度更高。我们将这些数据与包括抗生素使用情况、社会脆弱性、畜牧养殖规模、医疗设施密度和机场存在情况等全国数据集相结合，以调查耐药性的潜在驱动因素。我们还生成了美国每个县的ARG浓度预测图。我们发现社会脆弱性指标（过度拥挤、住房负担和医疗保险覆盖情况）以及国际旅行指标与废水中ARG浓度的增加有关，而抗生素使用仅呈微弱的正相关。我们的研究结果提供了ARG浓度的全国基线，并突出了推动抗生素耐药性传播的因素的复杂性。
