Antimicrobial Resistance and Bacteriophages: An Overlooked Intersection in Water Disinfection

From a precautionary viewpoint, monitoring of phages and ARGs should be included when designing and developing new disinfection treatments aimed at removing possible AMR risks from treated water. Investments in upgrading wastewater treatment plants to decrease AMR risk in treated waters are on the horizon for the water industry. Deployment of disinfection to remove phages and the related AMR risk needs further assessment. The method should be cost-effective and should not trigger horizontal gene transfer side-effects. Membrane filtration methods are promising technologies to remove both phages and ARGs, but these still need to decrease in cost. This article focuses on how bacteriophages (phages), antibiotic-resistance genes (ARGs), and disinfection practices intersect. Phages are considered to be the most abundant biological entities on Earth and they have the potential to transfer genes (including ARGs) among their bacterial hosts. In the urban water cycle, phages are used as indicators of fecal pollution and surrogates for human viral pathogens but they are also known to withstand common disinfection treatments deployed to produce safe drinking/reclaimed water. Recent studies also suggest that phages have the potential to become an additional footprint to monitor water safety. A precautionary approach should therefore include phages in surveillance programs aimed at monitoring antimicrobial resistance (AMR) in the urban water cycle. This article argues that phages ought to be used to assess the efficiency of disinfection treatments (both classical and novel) on reducing the risk associated with antibiotic resistance. Finally, this article discusses contributions to the advancement of AMR stewardship in aquatic settings and is relevant for researchers and water industry practitioners. This article focuses on how bacteriophages (phages), antibiotic-resistance genes (ARGs), and disinfection practices intersect. Phages are considered to be the most abundant biological entities on Earth and they have the potential to transfer genes (including ARGs) among their bacterial hosts. In the urban water cycle, phages are used as indicators of fecal pollution and surrogates for human viral pathogens but they are also known to withstand common disinfection treatments deployed to produce safe drinking/reclaimed water. Recent studies also suggest that phages have the potential to become an additional footprint to monitor water safety. A precautionary approach should therefore include phages in surveillance programs aimed at monitoring antimicrobial resistance (AMR) in the urban water cycle. This article argues that phages ought to be used to assess the efficiency of disinfection treatments (both classical and novel) on reducing the risk associated with antibiotic resistance. Finally, this article discusses contributions to the advancement of AMR stewardship in aquatic settings and is relevant for researchers and water industry practitioners. genes that encode mechanisms of antimicrobial resistance (AMR). It should be noted that phages or other mobile genetic elements (MGEs) are not AMR determinants per se. AMR determinants are genes that encode proteins involved in AMR [65.Nesme J. Simonet P. The soil resistome: A critical review on antibiotic resistance origins, ecology and dissemination potential in telluric bacteria.Environ. Microbiol. 2015; 17: 913-930Crossref PubMed Scopus (139) Google Scholar]. coordinated interventions designed to promote, improve, monitor, and evaluate the judicious use of antimicrobials to preserve their future effectiveness, and to promote and protect human and animal health [66.National Collaborting Centre for Infectious DiseaseGlossary of terms: antimicrobial resistance.https://nccid.ca/publications/glossary-terms-antimicrobial-resistance/Date: 2016Google Scholar]. the intrinsic or acquired ability of bacteria to withstand antimicrobial treatment. viruses that infect and replicate in bacterial cells. a process in which an organism (the donor) transfers genetic material to another organism (the recipient) of the same or different species. genetic elements which are identified as fragments of DNA that encode a variety of virulence or resistance determinants as well as the enzymes that mediate their own transfer and integration into new host DNA. Phages, phage-related particles, plasmids, genomic islands, integrons, and integrative conjugative elements (ICEs) are MGEs [11.Frost L.S. et al.Mobile genetic elements: The agents of open source evolution.Nat. Rev. Microbiol. 2005; : 722-732Crossref PubMed Scopus (923) Google Scholar,67.Sui Q. et al.Does the biological treatment or membrane separation reduce the antibiotic resistance genes from swine wastewater through a sequencing-batch membrane bioreactor treatment process.Environ. Int. 2018; 118: 274-281Crossref PubMed Scopus (25) Google Scholar]. a well known disinfection-by-products (DBP) agent characterized by its toxic and carcinogenic effects.