South Africa: Antibiotic Resistance Is Spreading Through South Africa's Water Systems - Study Explains How

Antibiotic resistance – the ability of disease-causing microbes to resist antibiotic treatments – is spreading through South Africa's water systems, according to a recent study. While often dubbed a "silent pandemic," antibiotic resistance already causes an estimated 1.27 million deaths annually, with Africa bearing the highest burden.

Traditionally, efforts to combat this resistance have centered on hospitals and clinics where antibiotic use is most prominent. However, antibiotic-resistant bacteria can multiply and transfer their resistance genes, spreading beyond healthcare settings via wastewater or human carriers.

Wastewater treatment plants, which clean what we dispose of and release the treated water back into rivers or reuse it, pose an overlooked pathway for this spread. These plants combine various contaminants, including antibiotic residues and resistant bacteria, in a single system. After treatment, some resistant bacteria remain in the water and release extracellular DNA, which can carry antibiotic resistance genes.

This genetic material can persist in treated water and, through environmental interactions, spread antibiotic resistance to other microorganisms.

Research conducted in South Africa reveals that even after standard wastewater treatment, extracellular DNA carrying antimicrobial resistance genes remains in the released water. Some of these genes are associated with resistance against antibiotics of last resort, used to treat severe infections in humans and animals. This does not imply that treated wastewater directly causes disease, but it indicates that resistance can survive treatment and potentially return to communities through drinking water, food, or recreational exposure.

Developing countries face greater challenges in addressing this issue due to limited access to safe water and sanitation, which may increase opportunities for these resistance genes to circulate from environmental sources to communities. A shift in perspective is necessary, as antibiotic resistance is not merely a medical concern but an environmental one as well. It requires a multi-faceted approach involving monitoring systems, wastewater treatment technologies, sector collaboration, and public awareness.

To effectively tackle antibiotic resistance, monitoring systems must evolve to detect genetic material using advanced molecular methods. While these techniques require specialized equipment and expertise, their integration into monitoring programs is becoming more feasible. Additionally, wastewater treatment technologies need to adapt by incorporating advanced processes like ozonation, ultrafiltration, and DNA-degrading enzymes, which have shown effectiveness in degrading extracellular DNA.

Several countries, particularly in Europe, North America, and Asia, are already implementing these technologies.

In South Africa, there are initial signs of adoption, such as the implementation of UV treatment in some wastewater treatment plants. However, broader adoption is needed. Enhanced collaboration among policymakers, engineers, microbiologists, and public health practitioners is also crucial, as antibiotic resistance transcends the medical field and impacts water management. Lastly, raising public awareness about the spread of antibiotic resistance through water is essential to garner support for necessary changes.