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Antibiotic resistance is one of the greatest threats to human and animal medicine1–3. As resistance emerges, the number of available and effective treatment options continues to decrease. Management of bacterial infections caused by resistant bacteria results in increased costs due to longer medication periods and potentially drug associated side effects. The problems associated with antimicrobial resistance is not limited to the health-care setting. To battle antimicrobial resistance, a One-Health approach is crucial as bacteria and antimicrobial resistance are found in all types of environments such as soil and water4. These are eco-systems shared by microbes that can infect both humans and animals. It is therefore important that different sectors working with agriculture, wastewater treatment or medicine, collaboratively work for healthier humans and animals as well as a healthy environment.


Kollage med djur- och vattenbilder
A One-Health approach within the fields of agriculture, wastewater treatment and medicine, is crucial when improving the health of humans, animals and the environment.

PARIWISE is a transnational research project with partners from five different countries: Norway, Spain, Sweden, Tunisia and Uganda. The aim of the project is to study the role of wastewater treatment plants (WWTPs) in dispersal of antimicrobial resistance and how it influences grazing cattle and aquatic birds in contact with surface waters. It is a qualitative study on the abundance of antimicrobial resistant bacteria, resistance genes and antibiotic residues in waterbodies, grazing cattle and aquatic birds. In addition, the role of birds in transmission of antimicrobial resistant bacteria will be studied.

Illustration över stad, reningsverk, natur
The PAIRWISE project studies the role of waste water treatment plants in dispersal of antibiotic resistance into the enrivonment and how it influences grazing cattle and aquatic birds in contact with surface waters.

WWTPs play an important role in management of wastewater prior to dispersal into the environment. The environmental impact is dependent on local antibiotic use, environmental factors, and WWTP size5,6. It has also been shown that the presence of antimicrobial resistance genes decreases with increased distance to a WWTP7. The environment provides an immensely diverse microbiome that could potentially be acquired by bacteria with the ability to cause disease in humans and animals4.

The project truly embraces a One-Health approach by including aquatic environments linked to both human and animals. Grazing cattle and aquatic birds in close proximity to WWTPs could potentially acquire resistant bacteria from the surface water. Mutations usually arise during treatment as the selection pressure promotes difficult to treat bacteria; such a strong selection pressure is rarely seen in the environment4,8. On the other hand, agricultural runoffs and leaching from farms could also contaminate surface waters. Further, wild gulls have been proposed to transmit antimicrobial resistant bacteria due to their presence in human settings9,10.


    1. Global antimicrobial resistance and use surveillance system (GLASS) report 2021. Geneva: World Health Organization; 2021. Licence: CC BY-NC-SA 3.0 IGO.
    2. WHO Regional Office for Europe/European Centre for Disease Prevention  and Control. Antimicrobial resistance surveillance in Europe  2022 – 2020 data.
    3. Swedres-Svarm 2020. Sales of antibiotics and occurrence of resistance in Sweden. Solna/Uppsala ISSN1650-6332.
    4. Larsson, D. G. J. & Flach, C.-F. Antibiotic resistance in the environment. Nat. Rev. Microbiol. 20, 257–269 (2022).
    5. Pärnänen, K. M. M. et al. Antibiotic resistance in European wastewater treatment plants mirrors the pattern of clinical antibiotic resistance prevalence. Sci. Adv. 5, eaau9124 (2019).
    6. Azuma, T. et al. Environmental fate of pharmaceutical compounds and antimicrobial-resistant bacteria in hospital effluents, and contributions to pollutant loads in the surface waters in Japan. Sci. Total Environ. 657, 476–484 (2019).
    7. McConnell, M. M. et al. Sources of Antibiotic Resistance Genes in a Rural River System. J. Environ. Qual. 47, 997–1005 (2018).
    8. Flach, C.-F., Genheden, M., Fick, J. & Joakim Larsson, D. G. A Comprehensive Screening of Escherichia coli Isolates from Scandinavia’s Largest Sewage Treatment Plant Indicates No Selection for Antibiotic Resistance. Environ. Sci. Technol. 52, 11419–11428 (2018).
    9. Atterby, C. et al. ESBL-producing Escherichia coli in Swedish gulls-A case of environmental pollution from humans? PloS One 12, e0190380 (2017).
    10. Ramey, A. M. et al. Antibiotic-Resistant Escherichia coli in Migratory Birds Inhabiting Remote Alaska. EcoHealth 15, 72–81 (2018).
Sidan granskades senast : 2022-06-14