Monitoring Antibiotic Resistance Spread Through Wastewater Surveillance at Mass Events

Mass gatherings, including major sporting events and festivals, attract large populations from diverse regions, creating opportunities for the spread of antimicrobial resistance (AMR). This threat compromises the effectiveness of antibiotics and presents significant public health challenges. To better understand how such events influence the dissemination of resistance genes, researchers have utilized wastewater surveillance to monitor changes in the presence of antimicrobial resistance genes (ARGs). The COVID-19 pandemic provided a unique baseline, as border closures temporarily reduced travel and large gatherings, allowing scientists to assess how the resumption of these events impacts local wastewater systems.

A recent study led by Changzhi Wang from King Abdullah University of Science and Technology analyzed wastewater samples collected from four treatment plants in Saudi Arabia between July 2020 and August 2022. These plants received sewage from areas hosting mass gatherings, alongside samples from a control site that did not receive such wastewater. Using metagenomic techniques, the study focused on ARGs conferring resistance to beta-lactam antibiotics, like metallo-beta-lactamase (MBL) and extended-spectrum beta-lactamase (ESBL). The results showed spikes in the abundance of these resistance genes following mass events in 2022, correlating with increased populations resistant to antibiotics such as meropenem and ceftazidime.

Additionally, the presence of resistance genes like blaPER was identified in pathogenic bacteria during peak gathering periods, suggesting that such events can introduce new resistance determinants into local environments. Notably, no resistant colonies were detected at the control site, which did not receive wastewater from large gatherings.

Researchers emphasized that traditional methods of monitoring might overlook subtle but critical changes in resistance patterns. Integrating genomics approaches with bioinformatic analysis offers a more comprehensive understanding of how mass gatherings influence AMR spread. Public health strategies could benefit from wastewater and water surveillance, especially in regions with inadequate wastewater treatment infrastructure, to anticipate and mitigate the risks posed by antimicrobial resistance.

This research underscores the importance of monitoring environmental reservoirs of resistance and highlights the potential of metagenomics as a tool in public health surveillance to combat the growing challenge of antimicrobial resistance, especially during large-scale events.