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Review

Antibiotic Resistance and Aquatic Systems: Importance in Public Health

by
Njomza Lajqi Berisha
1,*,
Ana Poceva Panovska
2 and
Zehra Hajrulai-Musliu
3
1
Department of Pharmacy, Medical Faculty, University of Prishtina, 10000 Prishtina, Kosovo
2
Department of Organic Chemistry, Faculty of Pharmacy, Ss. Cyril and Methodius University, 1000 Skopje, North Macedonia
3
Department of Chemistry, Faculty of Veterinary Medicine, Ss. Cyril and Methodius University, 1000 Skopje, North Macedonia
*
Author to whom correspondence should be addressed.
Water 2024, 16(17), 2362; https://doi.org/10.3390/w16172362
Submission received: 4 July 2024 / Revised: 7 August 2024 / Accepted: 16 August 2024 / Published: 23 August 2024
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Abstract

:
This review focuses on the crucial role of aquatic ecosystems in preserving biodiversity and the biosphere, as well as the connection between antimicrobial resistance (AMR) and these ecosystems. It provides an in-depth analysis of the link between ecological well-being and public health, helping readers understand this complex subject. Aquatic ecosystems are essential for maintaining biodiversity and ecological balance. Additionally, they act as primary reservoirs and pathways for the spread of antimicrobial resistance (AMR). These ecosystems risk antibiotic contamination through various sources, such as the release of antibiotics from animal and human waste, improper disposal of unused medications, and pharmaceutical industry waste management practices. The presence of antibiotic residues in these environments significantly speeds up the development of bacterial resistance. The global prevalence of antimicrobial resistance (AMR) is evident in freshwater bodies, tributaries, sewage waters, and wastewater treatment facilities. Antimicrobial resistance (AMR) is now a significant public health threat, compromising the effectiveness of many previously successful treatments against various pathogens. One notable and alarming aspect of antimicrobial resistance (AMR) is its rapid development, often occurring within 5–10 years after introducing antimicrobial drugs to the market. This acceleration is closely tied to bacteria’s ability to thrive and adapt in the presence of antimicrobial agents and their residues in the environment. The implications of antimicrobial resistance (AMR) include treatment failures with long-term effects and a continuous increase in healthcare costs. This review comprehensively examines the intricate relationship between aquatic habitats, antibiotics, and the global challenge of antimicrobial resistance (AMR). It emphasizes the critical role of these ecosystems in preserving ecological diversity. It raises awareness about AMR’s urgent public health issue, laying a foundation for understanding its extensive consequences.

1. Introduction

Microbial genomes possess intrinsic mechanisms that facilitate microbes’ adaptation, evolution, and survival in settings defined by a high abundance of antibiotics and other antimicrobial agents. Antimicrobial resistance (AMR) arises from a complex interplay combining selective pressures, genetic changes, and gene transfer events [1,2,3,4]. The One Health approach, which recognizes the interconnectedness and mutual influence of three domains: human, animal, and environmental health, is a testament to the power of collaboration in addressing antibiotic resistance. This approach involves a joint effort among various health science professions and their related disciplines to achieve optimal health for domestic animals, humans, wildlife, plants, and the environment. [5,6,7]. The irresponsible and excessive use of antibiotics in agriculture, livestock farming, and human medicine has led to a rapid increase in antibiotic resistance. The interconnections between livestock, humans, and environmental compartments create pathways for transmitting bacteria, mobile genetic elements (MGEs), and antibiotics, thereby promoting the spread of AR [8,9,10,11,12,13,14,15,16,17,18], see Figure 1.
Conjugation is a well-established mechanism for disseminating antimicrobial resistance genes (ARGs) [19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36]. Conjugation is a biological process characterized by the transient un-ion of two bacterial or unicellular organisms, enabling the transfer of genetic material, including crucial resistance genes.
Several empirical studies have shown evidence for antibiotic-resistant genes (ARGs) in animals, food products, and human populations. These findings highlight the concrete risk associated with the activation and spread of these genes to other organisms [37,38,39,40,41,42,43,44,45].
Aquatic settings are recognized as optimal repositories for the preservation and subsequent dissemination of antibiotic resistance genes. The potential transmission of these genes to human populations in aquatic environments presents a significant and well-acknowledged risk to public health [46,47,48,49,50,51,52]. The current methods used to purify drinking water and treat sewage are not effectively removing antibiotic-resistant genes from wastewater streams [53,54,55]. Bacteria can develop antibiotic resistance through mutations in natural aquatic environments, even when exposed to antibiotic concentrations 100 times lower than the minimum inhibitory concentration (MIC). Low antibiotic concentrations contribute to the prolonged survival of antibiotic-resistant bacteria (ARB) [56]. This issue is particularly relevant in agricultural settings, where effluents containing antibiotic-resistant microbes or their genetic material can easily enter water systems such as rivers, lakes, and various aquatic habitats [49,50,51,52,54,55,56,57]. Furthermore, using wastewater in agriculture and consuming products irrigated with reclaimed water can further spread antibiotic resistance [49,50,51,52]. Given the complexity of these interactions, there is an urgent need for comprehensive strategies to reduce the amplification and spread of antimicrobial resistance in aquatic environments and agriculture. It is crucial to implement efficient wastewater management and surveillance measures.

2. Antimicrobial Resistance in Water Bodies

Aquaculture is subject to critical examination due to its generally acknowledged role as a substantial catalyst for spreading antibiotic-resistant microbes and transmitting their genetic material. This phenomenon arises from implementing antibiotics in aquatic habitats through direct administration or their inclusion in the diet of marine creatures as a strategy for managing infections [58,59]. It is worth mentioning that antibiotics commonly used in aquaculture, such as macrolides and aminoglycosides, possess significant antibacterial efficacy and are regarded as powerful tools in combating infections in people [60], see Table 1.
Substantial data support a direct association between aquaculture and the transfer of antibiotic resistance genes from fish to specific human diseases, such as E. coli, Salmonella spp., and Aeromonas spp. [57,61,62]. The results of this study highlight the complex relationship between aquaculture methods and the possibility of transferring antibiotic resistance genes to harmful bacteria. This underscores the importance of closely monitoring and employing responsible antibiotic usage within the aquaculture business.
The relationship between aquaculture methods and the attribution of antibiotic resistance genes to the serotypes of S. enterica typhimurium DT104, which resulted in salmonellosis epidemics in Europe and the USA, is clearly demonstrated [62]. This finding supports the hypothesis that the aquaculture system may have substantially influenced the development of these resistant serotypes. In addition, it is worth noting that the prevalence of multidrug resistance (MDR) in Vibrio alginolyticus and Vibrio parahaemolyticus isolates derived from cultured fish in Korea highlights the ongoing phenomenon of gene transfer in aquatic environments [63]. This phenomenon transcends the confines of certain pathogens and embraces a wider range of microorganisms.
Metagenomic or culture-independent studies have further supported this assertion by uncovering antibiotic-resistance genes from diverse classes among marine sediments [33,64,65,66,67,68]. The results of this study definitively confirm the indisputable significance of aquatic habitats, particularly aquaculture systems, in the secondary dissemination of antibiotic-resistance genes. The increasing amount of evidence underscores the necessity for implementing a comprehensive strategy to tackle the problem of antibiotic resistance in aquatic ecosystems.
Table 1. Antibiotic classes: action and resistance mechanisms.
Table 1. Antibiotic classes: action and resistance mechanisms.
ClassAntimicrobial AgentMechanism of ActionResistance Mechanism
AminoglycosidesGentamicin, Kanamycin, StreptomycinInhibition of protein synthesis Efflux, enzymatic inactivation, mutated target
AmphenicolsChloramphenicolInhibition of protein synthesis Efflux
MacrolidesClarithromycin, ErythromycinInhibition of protein synthesis Efflux, mutated target
TetracyclinesTetracycline, DoxycyclineInhibition of protein synthesis Efflux
Beta-Lactams *Penicillin, Aztreonam, CefotaximeInhibition of cell-wall synthesisEnzymatic inactivation, mutated target
GlycopeptidesVancomycin, BleomycinInhibition of cell-wall synthesisCell wall modification, efflux
QuinolonesNalidixic Acid, CiprofloxacinInhibition of nucleic acids synthesisEfflux, mutated target
SulfonamidesSulfamethoxazoleInhibition of folate synthesis pathwayAlternative enzymes, mutated target
LipopeptidesDaptomycinCell membrane depolarization Cell membrane modification, mutations
Amino-acid derivatesPolymyxin BCell membrane permeabilizationCell membrane modification
Notes: * Divided into four subclasses: penicillins, cephalosporins, carbapenems, and monobactans. Adapted with permission from Reference [69]; Published by Perspectives in Water Pollution, 2013.

3. Antimicrobial Resistance in Freshwater and Wastewater

Freshwater ecosystems, encompassing various bodies of water such as rivers, streams, springs, and lakes, function as ongoing reservoirs for antibiotic-resistant microorganisms and their genetic components. These microorganisms and genetic elements originate from diverse non-aquatic sources, including effluents from industrial activities such as chemical and pharmaceutical plants, animal husbandry, and aquaculture. An extensive scientific study [67,68,69,70,71,72,73,74] has undeniably established the widespread occurrence of antibiotics and antibiotic-resistance genes in both surface and subsurface waters [75].
According to a study [75], it has been observed that the aquatic sediments in Eastern Siberia possess a diverse range of bacteria and genes associated with several genera, including Pseudomonas, Acinetobacter, Bacillus, Arthrobacter, and Xanthomonas. This finding highlights the cultural significance of Eastern Siberia in terms of its microbial biodiversity. It is worth noting that Actinobacteria, namely, those belonging to the genus Streptomyces, exhibit a high capacity for the production of antibiotics that hold great clinical significance. Various research conducted in parallel has revealed the disconcerting presence of multidrug-resistant bacteria that show resistance to aminoglycoside drugs such as gentamicin, kanamycin, and streptomycin, as well as chloramphenicol and tetracycline, inside the freshwater lakes located in Antarctica and Siberia [76,77].
Multiple reports have drawn attention to the introduction of antibiotic-resistant bacteria from various effluents, signaling an urgent need for action. A study by Boon et al. has underscored the widespread nature of this issue, with many bacteria exhibiting multiple antibiotic resistance (MAR) in various river sites in southeastern Australia. This study also revealed that native Pseudomonas bacteria showed even greater antibiotic resistance than fecal bacteria isolated from the same water [78]. Similarly, pseudomonades taken from groundwater were resistant to 4–7 antibiotics. According to this study, authors found that this antibiotic resistance resulted from groundwater contamination by sewage of wastewater treatment plants [79]. In a different part of the world, a study in high-altitude Andean lakes in Puna also noted a high level of multiple antibiotic-resistant bacteria isolated from the habitat of numerous flamingos [80]. As we can see from these studies, wastewater is the primary focal point of the antibiotic resistance dilemma, which serves as the most extensive reservoir of antibiotic-resistant microbes and their genetic material [81]. These entities are well-prepared for transmission across different sections of the water network through a variety of methods (see references [82,83]). The effectiveness of conventional wastewater treatment technologies in controlling the growth of these microbes and their genetic material is limited (see references [17,57,84]). The possibility for horizontal gene transfer is a matter of great significance, as it involves the transmission of antibiotic resistance genes across species borders, including those that are very relevant to human health [17,85]. The presence of antibiotic-resistance genes in the environment is generally recognized. However, their amounts may differ across different environmental compartments. The phenomenon of horizontal gene transfer, as depicted in Figure 2, surpasses species boundaries, facilitating the exchange of genetic material across species, including those that are genetically distant. An illustrative instance of this method is demonstrated by red aphids obtaining their red carotenoid pigment genes via horizontal gene transfer after their intake of fungi as a source of nutrition.
Multiple aspects of this phenomenon highlight the possibility of developing new antibiotic-resistant germs [86,87].
Water 16 02362 g002
Figure 2. Involved mechanisms in horizontal gene transfer. A clear example of this is the acquisition of antibiotic resistance mechanisms, virulent traits, and other resources the microorganism uses to guarantee its survival. Adapted with permission from Reference [88]; Published by MDPI Microorganisms, 2019.
Figure 2. Involved mechanisms in horizontal gene transfer. A clear example of this is the acquisition of antibiotic resistance mechanisms, virulent traits, and other resources the microorganism uses to guarantee its survival. Adapted with permission from Reference [88]; Published by MDPI Microorganisms, 2019.
Water 16 02362 g002
The enduring presence of these genes presents a significant obstacle, considering their well-known status as non-degradable entities that can be readily transmitted across many environmental settings [84,89,90,91,92,93,94,95,96]. Genes contributing to antibiotic resistance can persist in the environment and spread widely. Bacteria may have genes in their genomes that make them naturally resistant to antibiotics, which can vary among different types of bacteria. Advances in genetic techniques and bacterial genome sequencing have allowed for the identification of many genes that may contribute to antibiotic resistance. For instance, gene amplification is a common way for bacteria to become more resistant to certain antibiotics. These findings give insight into the potential future of antibiotic resistance.
Human and veterinary environments are equally important in terms of being sources of antibiotic-resistant microbes and their genetic elements. In these habitats, intestinal microorganisms regularly encounter elevated levels of antibiotics [46,96,97]. Bacterial organisms, as they move through the gastrointestinal tract, can acquire genes that confer antibiotic resistance through mechanisms such as conjugation or transformation. The bacteria retain these acquired genes until they are eventually expelled from the body in human or animal feces [57,97,98,99,100,101]. As a result, the release of sewage into different ecosystems can be identified as a significant center for the spread of antibiotic-resistant microbes [83]. The ongoing interdependence of several factors contributes to the continuous propagation and intensification of antibiotic resistance, thereby necessitating comprehensive approaches to mitigate its effects.

4. Antimicrobial Resistance in Marine Environments

Marine settings have been found to function as reservoirs for a significant proportion, specifically around 28%, of antibiotic-resistant genes in microorganisms, as documented in a study [102]. The terrestrial environment has an important role in expanding microbes and their genetic elements, substantially impacting marine ecosystems. Moreover, the effects of aquaculture operations, which are well-known for causing leaks in aquatic ecosystems, are another crucial element in this complex situation. In the context of marine salmon farms in Chile, 363.4 tons of antibiotics were utilized [103]. The complex network of transmission of antibiotic resistance genes, which occurs in terrestrial and marine habitats, should not be overlooked.
Moreover, the development of antibiotic resistance can occur in natural aquatic environments due to mutagenesis triggered by low antibiotic doses [104]. While the proportion of resistant mutants may seem very small, the long-term presence of anti-microbial throughout multiple generations can enhance the spread of resistance [56,69], see Figure 3. The network of transmission of antibiotic resistance genes, which occurs in terrestrial and marine habitats, should not be overlooked. Studies using culture-dependent and culture-independent approaches suggest global contamination of the water environments, including open oceans, and the widespread presence of antibiotic-resistant bacteria [105]. Although the fraction of resistant mutants is meager, the accelerated selection of antibiotic-resistant bacteria could occur over generations due to continued antimicrobial presence [106]. Hence, it is crucial to focus on aquatic settings and acknowledge their significant role in the origin and spread of these microbes and their genetic components.

5. Antimicrobial Resistance in Water and Public Health

Numerous studies have emphasized the significance of microbial resistance, encompassing both acquired and innate mechanisms, leading to a diminishing efficacy of antibiotics in combating infections [107,108,109]. Bacteria exhibit two unique kinds of antimicrobial resistance (AMR): acquired and innate [110]. The introduction of antimicrobials or their constituents into the environment can significantly impact the evolution of microbial communities by directly interacting with them. This can ultimately lead to the development of resistant strains [17,111,112]. Antimicrobial resistance (AMR) has undergone a significant transformation, emerging as a pervasive and formidable global challenge that poses a substantial risk to public health worldwide [24,25,60,110,111,112].
The presence of these resistant microbes leads to many pathological conditions that have significant implications for healthcare systems. These implications include extended hospital stays, problems, and frequent therapeutic ineffectiveness [24,109,112,113,114,115,116,117]. These infections can have more severe consequences in patients with compromised immune systems or those receiving treatments such as chemotherapy, dialysis, organ transplants, or major surgical procedures [112,118]. Managing infections caused by Gram-negative and Gram-positive bacteria has become increasingly intricate globally, presenting significant difficulties [10,111,119,120,121]. These difficulties are expected to endure as significant challenges within healthcare systems until at least 2040 [122,123]. Pathogens such as Enterococcus, Helicobacter pylori, Neisseria gonorrhoeae, Campylobacter spp., and others have been designated as high-priority by the World Health Organization (WHO) in developing novel antibiotics. This prioritization is primarily driven by the increasing frequency of microbial resistance [10].
According to documented evidence, municipal wastewater is found to have heightened levels of organic and inorganic chemicals, which directly contribute to the propagation of resistant strains and the development of antibiotic resistance [19,46,124]. Although wastewater treatment provides some control over bacterial concentrations, it is important to highlight that resistant bacteria are still found in drinking water distribution networks even after chlorination operations [125,126]. The spike in antibiotic resistance can be attributed to the disturbance of the intricate equilibrium between antibiotic-sensitive and antibiotic-resistant microbes in sewage settings.
To tackle this situation effectively, it is imperative to progress in wastewater treatment technologies and adopt a cautious attitude towards using antibiotics. These measures can reduce the occurrence of antibiotic-resistant microorganisms. The persistent exposure to antibiotics originating from various environmental sources has a detrimental impact on the composition of the intestinal microbiome, leading to the development of bacterial antibiotic resistance in both human and animal populations (see references [127,128]). According to recent reports, strains appear to resist existing antibiotic treatments, resulting in deadly consequences in certain instances [57,127].
One aspect that warrants additional investigation is the influence of resistant strains on the human microbiome [129]. It is concerning to note that forecasts suggest a significant rise in fatalities attributed to microbial resistance, with estimations from the World Health Organization [130] indicating a potential surge to 10 million cases by the year 2050. This prognosis substantially escalates from the recorded 0.7 million cases in 2019. The projected path outlined above would be accompanied by a decrease of around 3–4% in the global gross domestic product. This would result in a significant economic burden, estimated from 1 to 6 trillion dollars annually between 2030 and 2050 [23,131].

6. Discussion

Antimicrobials are crucial in preventing and treating infectious diseases in various domains, including animals, humans, aquatic organisms, plants, and livestock [26,39,129,132,133,134]. The presence of antibiotic residues permeates various ecosystems, originating from a range of sources, including animal and human waste, improper disposal of unused medications, byproducts of the pharmaceutical industry, and substances used to improve and protect the health of plants and animals [12,26,46,132]. Aquatic habitats are undoubtedly significant reservoirs and major donors of microbial resistance [12,27,64,71,75,133,135,136,137,138]. In aquatic environments, the issue of antibiotic resistance and the associated genetic elements is particularly concentrated in wastewater [22,27,71,139,140,141,142,143]. The available data suggest that there is a possibility of a 33% rise in the worldwide usage of antibiotics in the aquaculture sector. This increase would result in a substantial quantity of 13,600 tons, surpassing the previous usage of 10,259 tons in 2017 [133]. There is a significant body of information that confirms the persistent existence of microbes and their genes that are resistant to antibiotics in both surface and subsurface waters [17,33,72,135], sewage [46,144], and marine settings [145,146].
Metagenomic investigations, which provide a means by which to explore microorganisms that cannot be cultured, offer significant contributions to our understanding of the genetic makeup of complex microbial communities in wastewater. The quantity of specific antibiotic resistance genes within these samples is quantified using a numerical representation, commonly stated as “copies per cell” or “copies per milliliter (mL)”. Elevated numerical values indicate a heightened occurrence of these genetic elements among the microbial community, shedding light on the possible risks associated with the transmission of antimicrobial resistance (AMR) from wastewater to the environment and, subsequently, to humans through water sources. Consequently, this poses a significant public health concern [147].
In a recent study, the analysis of metagenomic data obtained from municipal and hospital wastewater samples revealed the detection of various antibiotics, including tetracycline, beta-lactams, and macrolides, and the identification of multidrug resistance genes. The quantification of these genes ranged from 0.06 to 0.98 copies per cell [66]. In a separate occurrence, the marine samples displayed 1.7 × 102 copies per base [148].
The prevalence of antibiotic resistance genes in surface water was at its highest point, with concentrations ranging from 1.57–700.58 × 102 copies/mL for penicillin. In comparison, groundwater samples exhibited concentrations ranging from 0.37–312.7 × 102 copies/mL [143]. A discernible hierarchy was observed in the data, wherein the “Blatem” gene exhibited the highest ranking at a concentration of 700.58 × 102 copies/mL. This was followed by ampicillin and OPR D, which had a 1.57 × 102 copies/mL concentration. Resistance genes TETM and TETA were found at levels ranging from 1.35 to 439.88 × 102 copies/mL. Within the Sri Lankan groundwater samples, specific identification of the TETM resistance gene was seen at a concentration of 215.99 × 102 copies per milliliter [148]. According to a study [143], diverse concentrations of erythromycin, amoxicillin, sulfamethoxazole, ampicillin, clindamycin, tylosin, vancomycin, tetracycline, and chloramphenicol have been identified in the canals and urban lakes of Vietnam.
Research conducted in Bangladesh has revealed a noteworthy association between antibiotic resistance gene sequences and bacteria originating from humans, as evidenced by studies investigating waters and sediments in rural and urban areas (R2 = 0.73; p < 0.01). This finding emphasizes that the unregulated release of untreated sewage can potentially facilitate the transmission of antibiotic-resistance genes [148,149,150].
A comprehensive study has shed light on the disparities in antimicrobial levels and the presence of antibiotic-resistance genes across multiple continents, including Africa, Asia, North America, South America, Oceania, and Europe [151]. The Oceanic region had a restricted presence of macrolide-resistant genes, while Africa, Asia, and South America displayed a higher prevalence of genes linked to sulfonamides and chloramphenicol. Vietnam, India, and Brazil have been identified as prospective regions where new antibiotic resistance mechanisms may arise [98].
The primary obstacle in tackling antimicrobial resistance (AMR) is the limited comprehension of the mechanisms contributing to resistant strains’ emergence [17,152]. There are two primary methods for detecting antimicrobial resistance: phenotypic and genotypic. Phenotypic methods entail measuring bacterial growth in the presence of antibiotics. In contrast, genotypic methods involve analyzing extracted DNA using DNA amplification or whole-genome sequencing techniques to identify resistance genes [153,154]. Healthcare personnel play a crucial role in mitigating the antimicrobial resistance (AMR) issue by imparting knowledge on antibiotic utilization, its potential adverse effects, and appropriate disposal techniques for drugs and contaminated objects. To address the emergence and spread of microbial resistance successfully, it is imperative to advocate for promoting advanced tactics and novel technologies. Micro- and ultrafiltration in membrane bioreactors can act as an efficient barrier to antibiotic resistance in wastewater. Additionally, advanced non-submerged membrane treatment of wastewater effluent will likely yield similar results. The membrane’s pore size is critical for retaining bacteria and genes, while forming cake layers may contribute to overall performance. Results from studies on granular media filtration are preliminary, as relevant operational parameters are often not specified [155]. However, some findings indicate significant potential for filter optimization to remove several orders of magnitude. Research on biologically active systems operating with longer retention times, such as groundwater recharge and bank filtration, is currently lacking [156]. The removal of antimicrobial resistance genes (ARGs) through oxidation and disinfection is closely linked to the mode of action of the respective oxidants. Disinfection processes are an effective barrier for pathogenic bacteria, regardless of whether they carry AMR. However, it is worth noting that wastewater ozonation is often designed to remove trace organic chemicals. It may not be considered a reliable disinfection process at this dose, typically achieving approximately 1–2 log inactivation for bacteria [157,158,159]. Furthermore, the combined effects of advanced treatment processes should be explored concerning removing antibiotic resistance, including nanotechnology to treat water sources on the surface and beneath [17,152,153,154,155,156,157,158,159,160].
The phenomenon of microbial resistance presents a double challenge, impacting both the well-being of individuals and the overall economic stability on a global scale [59,161]. Estimations for Europe, the United Kingdom, Thailand, and the United States suggest that the costs associated with microbial resistance range from USD 340–680 billion, as directly indicated by reference [162,163]. In contemporary times, the issue of microbial resistance has garnered significant attention and support from various esteemed international organizations, such as the World Health Organization (WHO), Food and Agriculture Organization (FAO), Centers for Disease Control and Prevention (CDC), and the World Bank [164,165,166]. The present emphasis is not solely on mitigating antimicrobial resistance (AMR) but also encompasses the advancement of novel antibiotics with diverse modes of action [160,164,167,168,169,170]. Antimicrobial resistance (AMR) is a complex issue that requires coordinated tactics and the collaborative involvement of all relevant parties.

7. Conclusions

Antimicrobial resistance (AMR) is a significant global public health challenge. It is driven by inappropriate antimicrobial use and poor infection prevention and control across various health settings. Pharmaceutical manufacturing, livestock farming, aquaculture, intensive crop production, and healthcare pollution are key drivers of antimicrobial resistance (AMR). Although the pharmaceutical industry has helped to improve public health, untreated or inadequately treated waste from drug manufacturing factories often ends up in the environment, contributing to the build-up of drug-resistant microbes. The improper disposal of unused and expired medicines also fuels the spread of AMR. There must be a well-established model system for risk assessment of infections and deaths resulting from exposure to antibiotic resistance from environmental antibiotic residues. Such a model system would be potent in mitigating and monitoring ecological sources of resistance emergence and its transmission. In addition, the battle against antimicrobial resistance necessitates an increased dedication to scientific initiatives. To establish effective control methods, it is imperative to comprehend the extent and foundations of antibiotic resistance development thoroughly, as well as the sophisticated process by which resistance genes are transferred among pathogenic bacteria. To address the issue of antibiotic resistance effectively, it is imperative to develop comprehensive strategies that involve the prudent utilization of antibiotics and incorporate novel methods to reduce the establishment and dissemination of resistance. Involving local populations in the responsible use and appropriate disposal of antimicrobials constitutes a comprehensive and impactful strategy for promoting awareness of the dangers of antibiotic resistance. As per the EU Council’s recommendation on AMR, effectively addressing antimicrobial resistance (AMR) requires the cautious use of antibiotics for humans and animals, implementing good infection prevention and control measures, and increasing research and development into new antimicrobials and alternatives to antimicrobials. So, the key interventions include antimicrobial stewardship programs, clinical decision support systems for prescribers, control of falsified and counterfeit antimicrobials, infection prevention and control, and vaccination. Effective interventions in animal health include regulation and supervision, improved biosecurity, and vaccination. Environmental health settings could benefit from improving wastewater treatment facilities, limiting antimicrobials’ concentration in pharmaceutical industry discharges, and improving waste management in agricultural production. By cultivating a collective sense of responsibility among the general populace, we may actively contribute to the ongoing efforts to combat antimicrobial resistance (AMR), thereby ensuring the preservation of public health and the sustainability of our environment.

Author Contributions

Writing—original draft preparation, N.L.B.; Writing—review and editing, A.P.P.; Writing—review and editing, Z.H.-M. All authors have read and agreed to the published version of the manuscript.

Funding

This research received no external funding.

Conflicts of Interest

The authors declare no conflict of interest.

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Figure 1. Potential One Health drivers associated with antibiotic resistance. Adapted from Adapted with permission from Reference [18]; Published by Front Cell Infect Microbiol. 2021.
Figure 1. Potential One Health drivers associated with antibiotic resistance. Adapted from Adapted with permission from Reference [18]; Published by Front Cell Infect Microbiol. 2021.
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Figure 3. Functional mechanisms of the microbial resistome. Adapted with permission from Reference [69]; Published by Perspectives in Water Pollution, 2013.
Figure 3. Functional mechanisms of the microbial resistome. Adapted with permission from Reference [69]; Published by Perspectives in Water Pollution, 2013.
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Lajqi Berisha, N.; Poceva Panovska, A.; Hajrulai-Musliu, Z. Antibiotic Resistance and Aquatic Systems: Importance in Public Health. Water 2024, 16, 2362. https://doi.org/10.3390/w16172362

AMA Style

Lajqi Berisha N, Poceva Panovska A, Hajrulai-Musliu Z. Antibiotic Resistance and Aquatic Systems: Importance in Public Health. Water. 2024; 16(17):2362. https://doi.org/10.3390/w16172362

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Lajqi Berisha, Njomza, Ana Poceva Panovska, and Zehra Hajrulai-Musliu. 2024. "Antibiotic Resistance and Aquatic Systems: Importance in Public Health" Water 16, no. 17: 2362. https://doi.org/10.3390/w16172362

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