Global monitoring of antimicrobial resistance based on metagenomics analyses of urban sewage

Global Sewage Surveillance, Rene S. Hendriksen, Patrick Munk, Patrick Njage, Annamari Heikinheimo, Aivars Berzins

Research output: Contribution to journalArticleScientificpeer-review


Antimicrobial resistance (AMR) is a serious threat to global public health, but obtaining representative data on AMR for healthy human populations is difficult. Here, we use meta-genomic analysis of untreated sewage to characterize the bacterial resistome from 79 sites in 60 countries. We find systematic differences in abundance and diversity of AMR genes between Europe/North-America/Oceania and Africa/Asia/South-America. Antimicrobial use data and bacterial taxonomy only explains a minor part of the AMR variation that we observe. We find no evidence for cross-selection between antimicrobial classes, or for effect of air travel between sites. However, AMR gene abundance strongly correlates with socio-economic, health and environmental factors, which we use to predict AMR gene abundances in all countries in the world. Our findings suggest that global AMR gene diversity and abundance vary by region, and that improving sanitation and health could potentially limit the global burden of AMR. We propose metagenomic analysis of sewage as an ethically acceptable and economically feasible approach for continuous global surveillance and prediction of AMR.
Original languageEnglish
Article number1124
JournalNature Communications
Number of pages12
Publication statusPublished - 8 Mar 2019
MoE publication typeA1 Journal article-refereed

Fields of Science

  • 413 Veterinary science
  • 416 Food Science

Cite this