Environmental AMR Surveillance
Despite recognition that the environment serves as a reservoir and transmission route for AMR, as of 2025 there is no systematic AMR surveillance in the environment across Europe, including the Nordic countries. Most data comes from research-driven initiatives.
Why Environment Matters
The One Health approach recognises that AMR can emerge and spread through environmental pathways:
- Resistant bacteria and antibiotic resistance genes (ARGs) released via wastewater treatment plant effluent into water sources
- Agricultural runoff carrying antimicrobials and resistant bacteria from treated sludge
- The environment as a mixing vessel where resistance genes can transfer between organisms
Wastewater as a Surveillance Tool
Wastewater monitoring has two distinct purposes:
| Type | What it measures | Insight provided |
|---|---|---|
| Untreated wastewater | AMR in sewage before treatment | Snapshot of AMR in the general human population (composite sample) |
| Treated wastewater | ARGs and bacteria released via effluent | Risks from AMR release into the environment |
Limitations
Wastewater monitoring currently has limited potential for predicting novel AMR threats. It is better suited for tracking known resistance patterns.
Nordic Initiatives
- Several Nordic countries have piloted regular sewage sampling for AMR monitoring
- Denmark has conducted pilot and research-based wastewater monitoring
- Weekly sampling of wastewater treatment plants since 2015 (PATH-SAFE programme)
- The EU Directive (EU) 2024/3019 introduces mandatory AMR surveillance in wastewater for the first time
Challenges
Environmental AMR surveillance differs fundamentally from clinical surveillance:
- Must address a far broader range of largely non-pathogenic microbes
- Complex and variable microbial communities with natural and human-introduced resistance
- Clinical sampling methods are not directly applicable to environmental settings
- Limited involvement of environmental authorities
- Lack of harmonised protocols for environmental monitoring
- Unclear what beyond wastewater should be monitored (soil? surface water? air?)
International Frameworks
- EU Council Recommendation (2023) encouraged monitoring AMR in soil and water
- EU Directive (EU) 2024/3019 - first mandatory requirement for AMR surveillance in wastewater
- EEA/Eionet project (2023–2025) - monitoring AMR in surface waters
- UN Environment Programme recognises environment as key AMR sector