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Socio-Ecological Coupling of Antibiotic Resistance

R. Sean Norman, University of South Carolina

31 March 2017

Increased emergence of microbial antibiotic resistance (AR) coupled with decreased pharmaceutical investment in antibiotic innovation threatens decades of health improvements and is now one of the gravest issues facing global health. To mitigate the long-term impact of resistance, the World Health Assembly recently endorsed the Global Action Plan on Antimicrobial Resistance, encouraging countries to adopt national strategies within two years. However, current models of global burden of resistance are incomplete due to inadequate surveillance and understanding of the complex connections impacting AR cycling. Most of our understanding of the burden of AR has come from surveillance within health care and community settings as part of the sociological cycle. However, during antibiotic treatment, more than half of antibiotic residues are passed through human urine and feces into sewage or directly into the environment. Furthermore, unused antibiotics are often directly discarded into sewage systems or the environment. Thus, sewage treatement facilities (WWTF) may act as a major route of transfer of AR factors (antibiotics, antibiotic resistance genes [ARGs], and resistant microbes) from the sociological cycle into the environment whereby they enter the ecological cycle. This socio-ecological coupling is likely enhanced within coastal regions due to continued increases in population density. Thus, this talk focuses on examining WWTFs in the coastal region of Charleston, SC as potential reservoirs, amplifiers, and socio-ecological couplers of AR to better understand the connections that influence long-term AR maintenance.