Chile’s wastewater carries a hidden record of drug-resistant bacteria, and a new UK-Chile network will read that record to predict where resistance emerges and how it spreads. Antimicrobial resistance (AMR) is rising fast enough to become a leading cause of death, yet the environmental side of the problem—how resistance moves through water, soil, and sewage—remains poorly understood. Chile has strong human and animal health policies against AMR, but its environmental monitoring has made no progress. This project fills that gap by treating wastewater as a surveillance system for the whole country. If the framework works, water treatment plants and public health agencies could use it to spot emerging resistance early and stop it before it reaches people. The research focuses on building a risk-assessment model that combines existing data with new sampling, so that Chile—and eventually other Latin American nations—can target their limited resources where the threat is highest. The work is applied from the start, designed to feed directly into policy and infrastructure decisions.
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Antimicrobial resistance (AMR) - the phenomenon whereby microorganisms that were previously treatable with antimicrobials become untreatable - is predicted to overtake cancer as the leading cause of death within the next two decades. The role that humans and livestock components play in AMR has received much attention and thus is broadly understood. In contrast, the environmental component of resistance lags behind, despite mounting evidence of its key role in the development, transmission and spread of AMR. Up to now, the global death burden of AMR has been difficult to quantify, but in a recent advance, the Latin American death burden has been calculated at approximately 11.5% of the global deaths associated to AMR. Within this region, Chile represents one of the leading countries in the control of antibiotic resistance, with one of the lowest mortality rates associated to AMR. Despite this, the level of antibiotic resistance in priority resistance pathogens of concern as defined by the World Health Organization, rose significantly by 4.6% in a decade (2005-15). This puts AMR-related infections as the third leading cause of death in the country. In the Chilean National Action Plan on AMR, a key policy document tackling the country's approach to this public health threat, self-reported progress on the implementation of the plan showed good progress in human, animal health, and agriculture, but no progress for the environmental sector. Our previous analysis of Latin American national action plans shows that this is a problem across the region, not just in Chile. Our aim is to fill this gap by launching a new international network — a UK-Chile collaboration using a systems approach to tackle antimicrobial resistance in the environment—involving a feasibility study and system modelling of environmental AMR in wastewater. We will quantify available data, knowledge gaps and associated risks to develop a risk assessment framework to prevent and reduce the spread of environmental AMR. This proposal combines the complementary skills of the UK team and Chilean collaborators, using data on AMR in wastewater to tackle the environmental threat of AMR. This new international collaboration represents a timely opportunity to embed Chile's leadership in the control of AMR in Latin America, specifically in the environment.
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