Behind the Tap: Antimicrobial Resistance (AMR) and Water Pollution

This Transcript is AI-Generated

Dana: Antimicrobial resistance or a MR is estimated to kill over a million people every year. This staggering figure has been climbing since the year 1990. We disrupted the balance between environments and human beings by introducing antibiotics in massive scale. How do we even begin to solve such a large problem?

Ana Almeida: The narrative around resistance needs to improve. If we tell better stories, I think we get better compliance, and we need to charge people more for when there is a breach, when there is a pollution issue.

Micah: In this episode, we'll explore how polluted water fuels the A MR crisis. Why fixing it is so difficult and how the people who can help might already be out there. I'm Dana Clemson. And I'm Micah Schweitzer. This is balancing the future from Metler Toledo. On this show, we delve into the world of science and technology and explore its transformative impact on our lives.

Let's jump in.

Dana: In 1928, Alexander Fleming discovered penicillin in a mouldy Petri dish. Just 20 years later, mass production of the first effective antibiotic began. This breakthrough went on to save millions of lives. Antibiotics have always and still do occur naturally. Evidence shows that over 2000 years ago, ancient civilizations in places like Serbia, China, Greece, and Egypt, used mould and certain types of soil to treat infections.

However, these days, we produce and consume antibiotics on a colossal scale. This rapid increase in manufacturing has driven many types of bacteria to evolve, making them harder to treat with antibiotics. MRSA or methicillin resistant staphylococcus reus, there's a reason most people call it MRSA is one of the best known AMRs, but there are of course, many, many more varieties.

Ana Almeida: We have, um, a very important issue in microbiology at the moment, which is the spread of anti-microbial resistant genes in bacteria through environmental loss water. So to waste water, that's the voice of Ana Almeida, an environmental and microbiology consultant. Ana has over 20 years experience in academia regulation and industry.

And this is a problem that actually is being highlighted by the latest release of the legislation called the Urban Wastewater Treatments Directive. It's a very recent piece of document that actually tells the European member states that they will somehow have to monitor for this contaminants, specifically for genes that could give resistance to microorganisms against antibiotics.

So I'm talking specifically about bacteria here. Remember the Urban Wastewater treatment directive, we'll be returning to it later. We have really a pronounced increase of resistance in infections in general. And people are unfortunately dying or getting really sick without possibility of treatments because the bacteria is just too resistant to what's available to treat infections.

So understanding how that problem is spreading in the environment because of pollution, because of lack of appropriate treatment is very important and it's something that the European Commission is quite concerned about. Before we dig more into this, could you just explain to us maybe in simple terms, what is antier brail resistance?

Sure. We have bacteria that are good for us. Like, you know, lactobacillus, we have in our guts, they are fantastic, but we have microorganisms that are in the environment and they are not worried about us. They just are in the plants and in the water. And there are the microorganisms that are pathogenic. So these guys, they find our body particularly attractive to reproduce and multiply.

So they infect us and cause disease. So we take an antibiotic, we have an infection. The microorganism just simply throw away the antibiotic. It does nothing to it. That particular organism, that infection you have, has already a resistant gene for that antibiotic. You are gonna take the antibiotic, it's gonna be doing nothing for you.

You're gonna continue to be sick. And what microbes are we talking about? Which ones are most commonly resistant? The WHO has a very, um, interesting list called the, I think it's the pathogen priority list, and they update that every year. So these are the microorganisms that are most frequently causing problems in hospitals.

We have, uh, e coli, pseudomonas, osa, there are some fungi as well coming on the list. Now they are in the priority list because the statistics of the infections are increasing and they're becoming more frequent and they're becoming more untreatable. So when people go to the hospital to have an operation, or they go to have a C-section, they're more at risk because.

The antibiotics available cannot treat some of those infections. So it's, it's a huge medical problem at the moment. Are we meddling with things at an evolutionary level here? Potentially. Potentially. We disrupted the balance between environments and human beings by introducing antibiotics in massive scales like the environment.

They are fungi, they produce antibiotics, they're naturally occurring on antibiotics, but we've decided to engineering them in massive production, which is great. But, uh, this really changed the balance between the environment and the microorganisms and us. And now, antimicrobial resistance rising is the price we're paying for it.

Micah: Does pollution in our water sources have any effect on antimicrobial resistance? It does. Pharmaceuticals in general, especially antibiotics, if they are present in drinking water or in very small amounts, they will challenge or they will provoke this bacteria to become resistant. And that's why it's so important to increase our control of what's being discharged and how the wastewater, both from domestic and industrial usage, is being treated.

Dana: In late 2024, the European Union overhauled its 30-year-old urban wastewater treatment directive, laying down clear rules and tougher accountability for member states. A major update polluters now face extended producer responsibility. This polluter pays principle came into effect on January 1st, 2025, forcing producers to cover at least 80% of the cost of cleaning up their pollutants.

Micah: Financial accountability like this isn't new. In the nineties, the US Oil Pollution Act gave authorities the power to make companies pay for oil spill cleanups. But it will be interesting to see if shifting the financial burden to polluting manufacturers will drive down a MR in the coming years. For now, testing plays a key role in monitoring the issue.

Ana breaks it down into two main methods. One, you can have ager plates, you can do the standard microbiology cultivation with media that contains antibiotic, and then you're gonna see some profiles, but then you're gonna study one organism against one antibiotic. Is this really telling you the full picture?

Ana Almeida: It's telling you something. And then the challenge is, you know, this regulators, which organism are we gonna test? For which media? Which antibiotics? So this is the first problem. The general way we test for faecal contamination, re coli or some other microorganism does not work for antimicrobial resistances.

It's different problem, different way to test. The way you need to test it is extract the genetic material from the water samples you get. Not one organism, not one antibiotic. You process that the water in a very complicated way to extract the genetics of the bacteria in the water. And then you're gonna use some genomic technique to map what genes are there and what organisms are there.

To do that, you need to have a very good molecular biology laboratory. You need to have stuff trained in doing DNA extraction, which is not simple to get to a level where you actually get good techniques. It's a near two at least. And you need access to laboratories that will do the libraries and understand what exactly is the genetic component on that sample.

What is it telling you? And then you need somebody to interpret the data. So it's, it's a completely different, let's say, complexity level that we have. It's possible. Research laboratories do that all the time. They have the staff, they have funding. When you go to the water utility level, and even if you pay a laboratory to do that test for you, then you see the cost multiplied per sample.

Dana: How far away are we from being able to detect a MR at scale? I think the first problem that needs to be tackled is the way these chemicals are arriving in the environment. And we need to decrease pollution. And that's a big ask, but I think people are starting to realise the problem. I think this is a huge communication issue we have between science knowledge and who is causing the pollution, who is absorbing or suffering the effects of pollution.

Ana Almeida: If we tell better stories, I think we get better compliance and we need to charge people more for when there is a breach, when there is a pollution issue, companies need to pay. I think this is also a financial mechanism that needs to be stricter. What kind of challenges do these wastewater treatment plants have?

Dana: Are they all testing in the same way? Are they testing differently? How does it work? I think one of the, at least my experience working both as a researcher and a consultant for different environmental agencies, is that there is a lot of, uh, difference in the access of, um, I'm talking on European level.

Ana Almeida: Each member stage, each country has different possibilities to implement a certain regulation. It's expensive to do microbial testing. It's not something. That, um, it has a huge cost and you have to test samples on a certain frequency that also will have a cost. So the answer is the most wealth is the country.

The test is gonna be more intensive. Countries that have difficulty with their economists are gonna have less testing. This is the general scenario. At the moment, we're not testing, as far as I'm aware, we're not testing for antimicrobial resistance at the water utility level yet in Europe. I think this will come into play in the next years because the directives asking for that.

And we have a cost. But the challenge is to implement a method that's actually affordable. Otherwise, how the water utilities are gonna do that. So if it's not being tested at the utility level, where is it being tested in laboratories? So in pilot scale, in the research laboratories of the commission, they're trying to draw conclusions at the moment on the best effort, the best method to be testing that in large scale.

Micah: Just from my own understanding, like what water sources are they testing? Are you just going out to a river somewhere and scooping out some water? Or is it closer to the actual wastewater treatment? What point of the water system is this testing happening? This problem of antimicrobial resistance, you would be more waste.

Ana Almeida: Water o utility target is more concentrated. You have the pharmaceuticals, you have the waste of the cities, people, the hospitals. So generally what they do is they're gonna test before the wastewater treatment plants in the inlet, in the outlet. And then depending of where your drinking water is being sourced, you're gonna identify points that are more critical.

It's also gonna depend on location of your industry. Effluence, where that's more critical agriculture is also, it really depends on how the geography of your pollution sources is distributed. So you have, you need samples that are from the river and you need samples that are actually from the wastewater treatment plant to do, um, a good risk assessment of this problem.

Dana: We don't often think about where the water from our dishwasher or toilet goes, but usually wastewater eventually ends up in treatment. Plants in Europe, water from pharmaceutical sources must meet strict standards before it's released into the environment. But this is not the case everywhere. We've talked a lot about the environmental impact of antibiotic waste, but what about the impact on human health?

Ana Almeida: I think it's the question that's plaguing researchers, how much that environmental risk is transferred to people. But from publications in the area, you see that the amount of um, bacteria that are resistant to antibiotics close to effluence from pharmaceutical influence is gonna be higher. The environmental pressure to select for that resistance is there.

So how that goes back to people, it really depends on the number of factors like the individual immunity. So is that person more sensitive? Has is immunocompromised the exposure that person has to the water source? Maybe for me it doesn't do anything for us here because we're healthy, but for a child or for an elderly, that person could get an infection.

So their models explaining the risk for different group categories and in different regions. And what I advise to people generally about environmental risk in general, every place in Europe has a water office or a government agency that's responsible for the environmental quality. Your air, your water, they have to send and publish this information for us and we can know exactly how certain risks are quantified and are we are exposed to.

So this information in general is something we, we have to have access. I wanna jump back into the challenges with monitoring the water contamination. 'cause we touched on it a little bit, but just to go over the challenges again. You had mentioned cost as a big problem for some countries, regulation. Is there anything else that's a challenge when it comes to this?

Dana: I think it's the skilled people to work interpreting the data. That's a problem. And I think this is, it's not only interpreting the data, but people that actually take the value of all these tests and, uh, analyse the results and bring to us the users, the population, what is going on. We don't have enough communication from the science and the regulatory implementation of that science and those standards to people, to end users.

Ana Almeida: Very few people know how to source the information, how to get value, how to know what is it for me. We don't have enough scientists or qualified people that can actually tell better stories about what's going on in the environment. And um, I think this is a huge field of opportunity because fundamentally what you're talking about is something that sounds like it could be quite abstract, you know, testing water for certain microbe characteristics, but in the end what you're talking about is human health, which is each of us individually.

Yeah. The field is, has such a complexity and. Our narrative around these problems is very poor. That's what I'm trying to say. First of all, this is taxpayer money. So people are paying for the science behind that funding, that they're not getting the value out of it. They're not getting the information they need.

I think this is really something that, especially PhDs in biology, people that qualify so much could really be exploring that communication better. You've talked about the need for testing so that we know where to target the problem or exactly what the problem is that we're targeting. This of course, requires people, as you said, so how can educational institutions and industries collaborate to create this skilled workforce that's needed for this work?

I have a feeling, and I know a lot of scientists in Europe between let's say 30 and 45 years old, that have been qualified doing either PhDs or post doctorates and very skilled people. I think a lot of that qualification is already there. Um, but the transferring of those skills into industry and into regulatory agencies or businesses that can use those skills is not happening as fast or as effectively as it could happen.

So it's about qualifying people, but it's also about finding way for the people that are already qualified to come to the Marketing PACS and bring change. What could happen five, 10, or 20 years down the line if we don't get a MR under control. At the start of this episode, we mentioned a 2024 report from the Global Research on antimicrobial resistance or Gramme project, which estimates that over a million lives have been lost to a MR every year since 1990.

Micah: The report also forecasts that between 2025 and 2050, a total number of deaths could reach 39 million published in The Lancet. The study emphasised that without major changes in legislation, we can't hope to reverse this crisis, but there's another key part of the solution, a better narrative around appropriate antibiotic use.

Here's Anna again. So we have two problems there. One is infections that, like an influenza as they call in Italy, a viral infection that last seven days don't need antibiotics. And people often want one and they don't need, because not only it's not gonna do anything for them, it's gonna make them worse because when you take an antibiotic, you don't need it all.

Ana Almeida: Your microbiota is kind of effect, if not killed. And then, oh, there is a huge, you're, you're basically beating up your immune system by taking an antibiotic. And the second problem is when we have boxes of medicines that are not used, they need to go back to the pharmacy and properly manage. They're not supposed to go down the drain, they're not supposed to go into the bin.

They need to go back to whoever can manage the, that waste properly. So this is on us, the users. Where is the bigger source of this? Is it really, you know, us taking antibiotics or is it more the industrial use of antibiotics at scale on farms? That's a good question. I think it depends on the production sites and it probably the statistics of that Donna is gonna change depending on the country and how your industry group is compliant with the wastewater guidelines.

So this is one question. I think in general, countries that have better economical status and um, social situation tend to have a better balance. So less pollution from the production site and front the end users. But in terms of how much each one is contributing for the problem, I don't know that answer.

Micah: But what I'm hearing, I guess, I mean Dana was sort of saying, you know, is it most of the responsibility over here and less of the responsibility over here? And what I'm hearing you say the exact numbers not withstanding is that the responsibility is everywhere. The responsibility is shared, the source of this pollution is widespread.

Ana Almeida: That's right. That's right. I think animal use is a huge problem that, because it's massively used sometimes I don't think in Europe that's allowed anymore. But in other regions of the global, then it comes the global aspect of this problem. Sometimes we are fine here in Europe and the US we're controlling things.

But then this other region of the globe where the pro the, the antibiotic is being produced, imported into our market, they're not controlling the influence properly, they're not disposing properly, the waste. And then the bacteria emerges there and travels here and the problem spreads here. So there is that element of, uh, it's not only a local compliance issue, but a global aspect that we need to also consider.

Think so if we take a positive view forward, if we can create better, more robust contamination detection methods, what's the outcome? The outcome is when we have these answers more clear and we know exactly where are areas in Europe that are more problematic, we can go back to either the water utility and say, your wastewater treatment plant.

We need to be upgraded with these treatments to remove these pollutants we found that are more frequent. So we're gonna do that here. This is the funding, this is the financial mechanism we're gonna give to your region. And the other thing is, I think also from a business point of view, for companies that are working on these solutions, either as a treatment or detection, there is a huge market there to be explored, to be talked, to, be shared, and to expand.

So anyone that's working with environmental solutions today, and it's telling good stories, it has a good narrative, has something very good to be sold for water utilities, for who want, we need to buy those solutions. So we need to improve our environmental quality. And uh, I think this is how I would see it, kind of the long term solution and how things could kind of communicate together to improve our environmental quality.

Anna, would you say anti-microbial resistance is a part of life at this point? It is, it is. I think we, we need to really accept that pollution is there, there is only so much we can do about it. And we have to kind of be in a good mental state because keeping acceptance of there are certain things we cannot change right now.

They're there, they need to improve, but we also need to leave. And it is part of life. We do our best to combat this problem by being healthy, but by taking care of us, of our families, avoiding places that are polluted and, uh, we do, we taking firm decisions on the best we can do, Micah, but we also need, from a human point of view, letting go of it.

Because otherwise we're kind of, oh my God, everything is done. We can't do this. What advice would you give to somebody early in a science career or an en an environmental profession who could contribute to these solutions? I think it's, if there is one skew we need in scientists today is communication.

And to communicate, you need to understand who that information is going to useful for. Regulators, businesses, and people do a good market research to try and understand how your qualifications could address some of the problems we have today. We have so many problems. Every scientist I know could find a niche to work, to construct beautiful narratives online and to find people to collaborate and bring solutions faster and more efficiently to people.

So tell good stories. Learn that gift. It's a beautiful use of your time and certainly gonna help you in your career.

Dana: We've been speaking to Ana Almeida, an environmental and microbiology consultant. Micah, what are your thoughts on this conversation we had with Ana? Well, it struck me, of course, how grave the problem is and how important it is to find solutions to it. Um, this issue of antibiotic, uh, microbial resistance, but obviously it's a very multifaceted problem.

Yeah. With all of the challenges with effective regional regulations like those in Europe, without this overall global consistency. Yeah. I mean, the bacteria, I suppose don't care about national borders. They'll adapt to whatever the conditions are, wherever they are. And so some kind of consistency, of course, would be to our benefit if we could, uh, somehow reach that at a regulatory level.

And I think just adding to the overall problem is how complex and difficult this testing process is. That's something that really surprised me. I thought it would be something that could easily be added into the steps that are taken in wastewater testing, but to hear that the science is so complex behind it, that was something I didn't realise.

Micah: Yeah, and I think that's an important point. You know, that we don't put all the burden on the scientific community to, to do the testing when in fact we need to look further upstream to prevent the problem from coming downstream, as it were. But on the other hand, I think that's a very hopeful note in the conversation, that there are people who are trained, who are ready, and who are capable of being on the front lines with testing.

So I think, you know, it goes both ways to a certain degree,

Dana: this has been balancing the future from Metler Toledo. What questions about science and technology do you want answered in a future episode? Let us know by leaving a review or if you're a Spotify user, leave us a message in the comment section and be sure to subscribe wherever you get your podcasts.

We'll be back in two weeks with our next episode. See you then.