Enhancing surveillance of antimicrobial resistant organisms in British Columbia through community-level wastewater testing

Antimicrobial resistance surveillance in British Columbia currently relies mainly on hospital data, which overlooks community-level trends. This study demonstrates that wastewater surveillance can fill this gap by detecting and quantifying key antimicrobial resistance genes (ARGs) in the community. Four ARGs (blaOXA-48, blaNDM, blaKPC, and mcr-1) were consistently found year-round in wastewater from five treatment plants, with blaOXA-48 being most prevalent. Seasonal peaks—mainly in winter and spring—were observed in wastewater but not reflected in clinical data, and mcr-1 was detected despite minimal clinical reporting. Overall, the findings show that wastewater surveillance provides early and complementary insights into AMR trends and can strengthen antimicrobial stewardship when integrated with traditional surveillance systems.