A review of wastewater-based epidemiology for antimicrobial resistance surveillance

Antimicrobial resistance (AMR) is a growing global public health threat, driven largely by the overuse and inappropriate prescribing of antibiotics in human and veterinary medicine. Traditional surveillance systems face limitations in tracking how resistance spreads across populations and within the microbiome of healthy individuals. Wastewater-based epidemiology (WBE) is emerging as a complementary surveillance approach that analyzes pooled community wastewater to monitor resistant bacteria in real time. This method can help detect trends in AMR and provide early warnings of outbreaks, strengthening existing infectious disease surveillance systems.