Antimicrobial resistance in rural rivers: Comparative study of the Coquet (Northumberland) and Eden (Cumbria) River catchments.

Many studies have characterised resistomes in river microbial communities. However, few have compared resistomes in parallel rural catchments that have few point-source inputs of antimicrobial genes (ARGs) and organisms (i.e., AMR) - catchments where one can contrast more nebulous drivers of AMR in rural rivers. Here, we used quantitative microbial profiling (QMP) to compare resistomes and microbiomes in two rural river catchments in Northern England, the Coquet and Eden in Northumberland and Cumbria, respectively, with different hydrological and geographical conditions. The Eden has higher flow rates, higher annual surface runoff, and longer periods of soil saturation, whereas the Coquet is drier and has lower flowrates. QMP analysis showed the Eden contained significantly more abundant microbes associated with soil sources, animal faeces, and wastewater than the Coquet, which had microbiomes like less polluted rivers (Wilcoxon test, p < 0.01). The Eden also had greater ARG abundances and resistome diversity (Kruskal Wallis, p < 0.05), and higher levels of potentially clinically relevant ARGs. The Eden catchment had greater and flashier runoff and more extensive agricultural land use in its middle reach, which explains higher levels of AMR in the river. Hydrological and geographic factors drive AMR in rural rivers, which must be considered in environmental monitoring programmes.

Environmental surveillance of antimicrobial resistance (AMR), perspectives from a national environmental regulator in 2023.

The development, and in some cases increasing prevalence, of resistance to antimicrobials used in clinical and veterinary settings has long been recognised. In recent years, the concept of 'One Health' has added recognition of the role that the environment plays in health protection along with the need for protection of the health of the environment itself. Organisations including the World Health Organization, United Nations Environment Programme, and national governments have identified a need for surveillance of antimicrobial resistance in the environment to sit alongside the surveillance carried out in clinical, veterinary and food sectors. However, having recognised the need for environmental surveillance there are multiple challenges in deciding what this should entail. For example, what pathogens or genes to monitor, who or what we wish to protect and what measures we wish to enable to decrease infection risks. That might include sampling near a source of resistant organisms entering the environment or conversely sampling where the exposure actually occurs. Choices need to be made at both policy and technical levels based on the detailed purposes of surveillance. This paper discusses these issues from the perspective of a national environmental regulator.

Antifungal medicines in the terrestrial environment: Levels in biosolids from England and Wales.

Antifungals are used widely in clinical and agricultural practice to control fungal growth, either treating or preventing infection. There are reports of increasing prevalence of resistance to antifungals in human pathogens and concern that their use in agriculture is driving clinical resistance in patients. While crop protection products are the most obvious source in agriculture, a further source may be biosolids from wastewater treatment. In the UK, these are applied to land to provide nutrients and improve soil structure for crops. In this study, biosolids from ten sites in England and one in Wales were analysed for clinical antifungals. Ketoconazole and miconazole were detected in all samples with a median concentration of 0.87 and 0.54 mg kg-1 dry weight (DW), respectively. Clotrimazole was detected at seven of eleven sites at a median level of 1.32 mg kg-1 DW and its absence at four others was considered treatment related. Two prescription-only and systemic medications, itraconazole and posaconazole, were frequently detected with median concentrations of 0.14 mg kg-1 DW and 0.09 mg kg-1 DW, respectively. The biosolid levels of itraconazole found in this study were two orders of magnitude higher than an indicative Predicted No Effect Concentration for resistance selection (PNEC-R) in soil. Neither fluconazole, griseofulvin, and voriconazole nor flucytosine and nystatin were found above the limit of detection of 0.01 or 0.1 mg kg-1 as received, respectively. The findings show that biosolids represent a viable pathway for antifungal agents to reach soil.

Antifungal Exposure and Resistance Development: Defining Minimal Selective Antifungal Concentrations and Testing Methodologies.

This scoping review aims to summarise the current understanding of selection for antifungal resistance (AFR) and to compare and contrast this with selection for antibacterial resistance, which has received more research attention. AFR is an emerging global threat to human health, associated with high mortality rates, absence of effective surveillance systems and with few alternative treatment options available. Clinical AFR is well documented, with additional settings increasingly being recognised to play a role in the evolution and spread of AFR. The environment, for example, harbours diverse fungal communities that are regularly exposed to antifungal micropollutants, potentially increasing AFR selection risk. The direct application of effect concentrations of azole fungicides to agricultural crops and the incomplete removal of pharmaceutical antifungals in wastewater treatment systems are of particular concern. Currently, environmental risk assessment (ERA) guidelines do not require assessment of antifungal agents in terms of their ability to drive AFR development, and there are no established experimental tools to determine antifungal selective concentrations. Without data to interpret the selective risk of antifungals, our ability to effectively inform safe environmental thresholds is severely limited. In this review, potential methods to generate antifungal selective concentration data are proposed, informed by approaches used to determine antibacterial minimal selective concentrations. Such data can be considered in the development of regulatory guidelines that aim to reduce selection for AFR.

Understanding and managing uncertainty and variability for wastewater monitoring beyond the pandemic: Lessons learned from the United Kingdom national COVID-19 surveillance programmes.

The COVID-19 pandemic has put unprecedented pressure on public health resources around the world. From adversity, opportunities have arisen to measure the state and dynamics of human disease at a scale not seen before. In the United Kingdom, the evidence that wastewater could be used to monitor the SARS-CoV-2 virus prompted the development of National wastewater surveillance programmes. The scale and pace of this work has proven to be unique in monitoring of virus dynamics at a national level, demonstrating the importance of wastewater-based epidemiology (WBE) for public health protection. Beyond COVID-19, it can provide additional value for monitoring and informing on a range of biological and chemical markers of human health. A discussion of measurement uncertainty associated with surveillance of wastewater, focusing on lessons-learned from the UK programmes monitoring COVID-19 is presented, showing that sources of uncertainty impacting measurement quality and interpretation of data for public health decision-making, are varied and complex. While some factors remain poorly understood, we present approaches taken by the UK programmes to manage and mitigate the more tractable sources of uncertainty. This work provides a platform to integrate uncertainty management into WBE activities as part of global One Health initiatives beyond the pandemic.

Dynamic baselines for the detection of water quality impacts - the case of shale gas development.

There is a need for the development of effective baselines against which the water quality impacts of new developments can be assessed. The specific conductance of flowback water from shale gas operations is typically many times the specific conductance of surface water and near-surface groundwater. This contrast in specific conductance means that specific conductance could be the ideal determinand for detecting water quality impacts from shale gas extraction. If specific conductance is to be used for detecting the impacts of shale gas operations, then a baseline of specific conductance in water bodies is required. Here, Bayesian hierarchical modelling of specific conductance was applied across English groundwater. The modelling used existing, spot-sampled data from the years 2000 to 2018 from 537 unique borehole locations. When the differences between boreholes was considered, then the approach was sufficiently sensitive to detect 1% mixing of fracking fluid in groundwater at a 95% confidence interval. The Bayesian hierarchical modelling maximises the return on public investment and provides a means by which future observations can be judged.

What is the risk of acquiring SARS-CoV-2 from the use of public toilets?

Public toilets and bathrooms may act as a contact hub point where community transmission of SARS-CoV-2 occurs between users. The mechanism of spread would arise through three mechanisms: inhalation of faecal and/or urinary aerosol from an individual shedding SARS-CoV-2; airborne transmission of respiratory aerosols between users face-to-face or during short periods after use; or from fomite transmission via frequent touch sites such as door handles, sink taps, lota or toilet roll dispenser. In this respect toilets could present a risk comparable with other high throughput enclosed spaces such as public transport and food retail outlets. They are often compact, inadequately ventilated, heavily used and subject to maintenance and cleaning issues. Factors such as these would compound the risks generated by toilet users incubating or symptomatic with SARS-CoV-2. Furthermore, toilets are important public infrastructure since they are vital for the maintenance of accessible, sustainable and comfortable urban spaces. Given the lack of studies on transmission through use of public toilets, comprehensive risk assessment relies upon the compilation of evidence gathered from parallel studies, including work performed in hospitals and prior work on related viruses. This narrative review examines the evidence suggestive of transmission risk through use of public toilets and concludes that such a risk cannot be lightly disregarded. A range of mitigating actions are suggested for both users of public toilets and those that are responsible for their design, maintenance and management.

Characterising the vertical separation of shale-gas source rocks and aquifers across England and Wales (UK).

Shale gas is considered by many to have the potential to provide the UK with greater energy security, economic growth and jobs. However, development of a shale gas industry is highly contentious due to environmental concerns including the risk of groundwater pollution. Evidence suggests that the vertical separation between exploited shale units and aquifers is an important factor in the risk to groundwater from shale gas exploitation. A methodology is presented to assess the vertical separation between different pairs of aquifers and shales that are present across England and Wales. The application of the method is then demonstrated for two of these pairs-the Cretaceous Chalk Group aquifer and the Upper Jurassic Kimmeridge Clay Formation, and the Triassic sandstone aquifer and the Carboniferous Bowland Shale Formation. Challenges in defining what might be considered criteria for 'safe separation' between a shale gas formation and an overlying aquifer are discussed, in particular with respect to uncertainties in geological properties, aquifer extents and determination of socially acceptable risk levels. Modelled vertical separations suggest that the risk of aquifer contamination from shale exploration will vary greatly between shale-aquifer pairs and between regions and this will need to be considered carefully as part of the risk assessment and management for any shale gas development.

Le gaz de schiste est considéré par beaucoup comme ayant le potentiel de procurer au Royaume Uni une plus grande sécurité énergétique, une croissance économique et des emplois. Cependant, le développement de l'industrie du gaz de schiste est fortement contesté en raison des problèmes environnementaux, qui comprennent le risque de pollution des eaux souterraines. Des données probantes suggèrent que l'isolation verticale entre les unités de schistes exploitées et les aquifères est un facteur important vis-à-vis du risque de contamination des eaux souterraines associé à l'exploitation du gaz de schiste. Une méthodologie est proposée pour évaluer la séparation verticale entre différents couples aquifères­schistes présents en Angleterre et Pays de Galle. L'application de la méthode est ensuite décrite pour deux de ces couples, d'une part l'aquifère du Groupe de la Craie du Crétacé et la formation des Argiles du Kimméridgien (Jurassique supérieur), et l'aquifère des Grés du Trias et la formation carbonifère des schistes du Bowland. Les enjeux de la définition de ce qui pourrait être considéré comme critère d'une « isolation sécuritaire ¼ entre une formation à gaz de schiste et l'aquifère sus-jacent sont discutées, en particulier au regard des incertitudes sur les propriétés géologiques, l'extension des aquifères et la définition des niveaux de risques socialement acceptables. Les isolations verticales modélisées suggèrent que le risque de contamination d'un aquifère lié à une exploration du schiste variera grandement d'un couple schiste­aquifère à l'autre et d'une région à l'autre et que cela devra être examiné avec soin dans le cadre de l'évaluation du risque et de la gestion de tout développement du gaz de schiste.

Muchos consideran que el shale gas tiene el potencial de proporcionar al Reino Unido una mayor seguridad energética, crecimiento económico y empleos. Sin embargo, el desarrollo de una industria del shale gas es muy polémico debido a las preocupaciones ambientales, incluido el riesgo de contaminación del agua subterránea. La evidencia sugiere que la separación vertical entre las unidades de shale explotadas y los acuíferos es un factor importante en el riesgo para las aguas subterráneas en la explotación del shale. Se presenta una metodología para evaluar la separación vertical entre los diferentes pares de acuíferos y los shales que están presentes en Inglaterra y Gales. La aplicación del método se demuestra para dos de estos pares­el acuífero Chalk Group del Cretácico y la Kimmeridge Clay Formation del Jurásico Superior, y el acuífero de arenisca del Triásico y la Bowland Shale Formation del Carbonífero. Se discuten los desafíos para definir los que podrían considerarse criterios para una "separación segura" entre una formación de shale gas y un acuífero superpuesto, en particular con respecto a incertidumbres en las propiedades geológicas, extensiones de acuíferos y la determinación de niveles de riesgo socialmente aceptables. Las separaciones verticales modeladas sugieren que el riesgo de contaminación del acuífero por la exploración del shale variará mucho entre los pares de shale­acuífero y entre regiones, y esto deberá considerarse cuidadosamente como parte de la evaluación y gestión de riesgos para cualquier desarrollo de shale gas.

O gás de xisto é considerado um potencial fornecedor de maior segurança energética, crescimento econômico e empregos ao Reino Unido. Porém, o desenvolvimento de uma indústria de gás de xisto é altamente controverso devido a preocupações ambientais, como o risco de poluição das águas subterrâneas. Evidências sugerem que a separação vertical entre unidades de xisto exploradas e aquíferos é um fator importante de risco para as águas subterrâneas na exploração de gás de xisto. Uma metodologia é apresentada para avaliar a separação vertical entre diferentes pares de aquíferos e blocos de xisto presentes em toda a Inglaterra e País de Gales. A aplicação do método é feita em dois pares­o Aquífero do Grupo Cretáceo Chalk com a Formação Argilosa do Jurássico Superior Kimmeridge, e o Aquífero de Arenito Triássico com a Formação Xistosa do Carbonífero Bowland. Os desafios para definir o que pode ser considerado critérios de "separação segura" entre uma formação de gás de xisto e um aquífero sobrejacente são discutidos, em particular no que diz respeito a incertezas em propriedades geológicas, extensões de aquíferos e determinação de níveis de risco socialmente aceitáveis. As separações verticais modeladas sugerem que o risco de contaminação do aquífero por exploração de xisto variará muito entre os pares de xisto­aquífero e suas regiões, devendo assim serem consideradas cuidadosamente como parte da avaliação e gerenciamento de risco para qualquer desenvolvimento de gás de xisto.

Review of Antimicrobial Resistance in the Environment and Its Relevance to Environmental Regulators.

The environment is increasingly being recognized for the role it might play in the global spread of clinically relevant antibiotic resistance. Environmental regulators monitor and control many of the pathways responsible for the release of resistance-driving chemicals into the environment (e.g., antimicrobials, metals, and biocides). Hence, environmental regulators should be contributing significantly to the development of global and national antimicrobial resistance (AMR) action plans. It is argued that the lack of environment-facing mitigation actions included in existing AMR action plans is likely a function of our poor fundamental understanding of many of the key issues. Here, we aim to present the problem with AMR in the environment through the lens of an environmental regulator, using the Environment Agency (England's regulator) as an example from which parallels can be drawn globally. The issues that are pertinent to environmental regulators are drawn out to answer: What are the drivers and pathways of AMR? How do these relate to the normal work, powers and duties of environmental regulators? What are the knowledge gaps that hinder the delivery of environmental protection from AMR? We offer several thought experiments for how different mitigation strategies might proceed. We conclude that: (1) AMR Action Plans do not tackle all the potentially relevant pathways and drivers of AMR in the environment; and (2) AMR Action Plans are deficient partly because the science to inform policy is lacking and this needs to be addressed.

A national-scale assessment of micro-organic contaminants in groundwater of England and Wales.

A large variety of micro-organic (MO) compounds is used in huge quantities for a range of purposes (e.g. manufacturing, food production, healthcare) and is now being frequently detected in the aquatic environment. Interest in the occurrence of MO contaminants in the terrestrial and aquatic environments continues to grow, as well as in their environmental fate and potential toxicity. However, the contamination of groundwater resources by MOs has a limited evidence base compared to other freshwater resources. Of particular concern are newly 'emerging contaminants' such as pharmaceuticals and lifestyle compounds, particularly those with potential endocrine disrupting properties. While groundwater often has a high degree of protection from pollution due to physical, chemical and biological attenuation processes in the subsurface compared to surface aquatic environments, trace concentrations of a large range of compounds are still detected in groundwater and in some cases may persist for decades due to the long residence times of groundwater systems. This study provides the first national-scale assessment of micro-organic compounds in groundwater in England and Wales. A large set of monitoring data was analysed to determine the relative occurrence and detected concentrations of different groups of compounds and to determine relationships with land-use, aquifer type and groundwater vulnerability. MOs detected including emerging compounds such as caffeine, DEET, bisphenol A, anti-microbial agents and pharmaceuticals as well as a range of legacy contaminants including chlorinated solvents and THMs, petroleum hydrocarbons, pesticides and other industrial compounds. There are clear differences in MOs between land-use types, particularly for urban-industrial and natural land-use. Temporal trends of MO occurrence are assessed but establishing long-term trends is not yet possible.

Review of risk from potential emerging contaminants in UK groundwater.

This paper provides a review of the types of emerging organic groundwater contaminants (EGCs) which are beginning to be found in the UK. EGCs are compounds being found in groundwater that were previously not detectable or known to be significant and can come from agricultural, urban and rural point sources. EGCs include nanomaterials, pesticides, pharmaceuticals, industrial compounds, personal care products, fragrances, water treatment by-products, flame retardants and surfactants, as well as caffeine and nicotine. Many are relatively small polar molecules which may not be effectively removed by drinking water treatment. Data from the UK Environment Agency's groundwater screening programme for organic pollutants found within the 30 most frequently detected compounds a number of EGCs such as pesticide metabolites, caffeine and DEET. Specific determinands frequently detected include pesticides metabolites, pharmaceuticals including carbamazepine and triclosan, nicotine, food additives and alkyl phosphates. This paper discusses the routes by which these compounds enter groundwater, their toxicity and potential risks to drinking water and the environment. It identifies challenges that need to be met to minimise risk to drinking water and ecosystems.

Intervention strategies for carcass disposal: pareto analysis of exposures for exotic disease outbreaks.

An enhanced methodology for the policy-level prioritization of intervention options during carcass disposal is presented. Pareto charts provide a semiquantitative analysis of opportunities for multiple exposures to human health, animal health, and the wider environment during carcass disposal; they identify critical control points for risk management and assist in waste technology assessment. Eighty percent of the total availability of more than 1300 potential exposures to human, animal, or environmental receptors is represented by 16 processes, these being dominated by on-farm collection and carcass processing, reinforcing the criticality of effective controls during early stages of animal culling and waste processing. Exposures during mass burials are dominated by ground- and surface-water exposures with noise and odor nuisance prevalent for mass pyres, consistent with U.K. experience. Pareto charts are discussed in the context of other visualization formats for policy officials and promoted as a communication tool for informing the site-specific risk assessments required during the operational phases of exotic disease outbreaks.

Exposure assessment of carcass disposal options in the event of a notifiable exotic animal disease: application to avian influenza virus.

We present a generalized exposure assessment of 28 disposal options for poultry carcasses in the event of a highly pathogenic avian influenza (HPAI) outbreak. The analysis supports a hereto unverified disposal hierarchy for animal carcasses, placing waste processing (e.g., incineration and rendering) above controlled disposal (e.g., landfill), above uncontrolled disposal (e.g., burial on-farm). We illustrate that early stages of the disposal chain (on-farm) pose greater opportunities for exposure to hazardous agents than later stages, where agents are generally contained, wastes are treated, and residues are managed by regulated processes. In selecting carcass disposal options, practitioners are advised to consider the full range of hazards rather than focusing solely on the HPAI agent, and to give preference to technologies that (i) offer high destruction efficiencies for target pathogens; (ii) do not give rise to significant releases of other pathogenic organisms; and (iii) do not release unacceptable concentrations of toxic chemicals. The approach offers an exposure assessment perspective for carcass disposal, thus providing a risk-informed basis for contingency planning and operational intervention. The authors recognize that relevant legislation, public perception, available capacity, and cost also need to be considered when selecting disposal options in the event of HPAI.