Integrating AMR surveillance into wastewater monitoring systems in 2025: a position on the implementation of Article 17 of the Urban Wastewater Treatment Directive (UWWTD)

The recast Urban Wastewater Treatment Directive (UWWTD) mandates monitoring of antimicrobial resistance (AMR) in wastewater from large European urban areas, prompting efforts to harmonise scope and methods across the EU; two joint actions — EU-WISH and EU-JAMRAI 2 — are developing guidance and indicators for wastewater-based surveillance (WBS) of AMR. A 2024 EU-WISH survey of 27 countries found that 11 currently operate AMR WBS, primarily using culture-based analyses, targeted resistance gene qPCR and, less frequently, metagenomics. The authors argue that prioritisation of AMR targets for WBS should align with public health objectives — such as trend detection, emerging resistance determinants in humans, environmental AMR releases and wastewater treatment performance — while balancing measurability, resource use and One Health expertise to ensure relevance and efficiency in implementation under Article 17 of the UWWTD.