Emerging investigators series: sewer surveillance for monitoring antibiotic use and prevalence of antibiotic resistance: urban sewer epidemiology

Sewer surveillance may be a useful tool for epidemiology that would benefit from improved understanding of the fate of microbial agents and prescription antibiotics during conveyance in sewer systems. The aim of this review is to provide an overview of the factors affecting the loading and fate of antibiotics and antibiotic resistant bacteria ( ARB) in sewer systems. A review of surveillance studies for antibiotics and antibiotic resistant bacteria is presented. Then, the role of potentially complicating sewer inputs ( e. g., the presence of health care facilities in a sewershed), and evidence for temporal variations in antibiotics and ARB are reviewed. Recommendations for best practices for sampling are made. Finally, evidence is presented for in-sewer attenuation of antibiotics and attenuation, growth and gene transfer for ARB. There is potential for, but limited evidence of, sewers serving as a reservoir for ARB growth and horizontal gene transfer. This review highlights the need for better understanding of ARB carriage in the general population and the impact of in-sewer processes on the fate of antibiotics and ARB.