Antibiotic resistance in the environment: expert perspectives

Antibiotic resistance is considered by different international organisations (e.g. World Health Organization, WHO; Food and Agriculture Organization of the United Nations, FAO-UN; Organisation for Economic Co-operation and Development, OECD) as not only a major threat to human life and wellbeing but also having tremendous economic impacts. Recent estimates indicate that globally at least 700,000 deaths per year are due to drug-resistant infections, with the largest and most important proportion of these attributable to antibiotic-resistant bacterial infections – and which are most often identified in hospitals. However, there are reasons to believe that antibiotic-resistant bacteria are common in the community, where they are acquired from other people, animals, foods, water and/or other environmental sources. Over recent decades, the importance of the environment in the propagation and dissemination of antibiotic-resistant bacteria has been better evidenced, with human and animal sewage representing the most important emission nodes in a complex network of transmission routes. While the relevance of environmental sources and paths of transmission are nowadays considered pivotal in any One Health discussion about antibiotic resistance, some key topics are still under debate in the scientific community. In this chapter, experts recognised in the field were invited to give their perspective on some commonly debated topics related to the risks and control of antibiotic resistance. Specifically, five invited experts gave their perspective on the relevance and control of the environmental dimensions of antibiotic resistance, based on six distinct thematic axes – transmission, critical control points, antibiotic-selective effects, interventions needed, authority’s awareness and engagement and priorities for action.