Antimicrobial resistance (AMR) is a growing public health concern in India and worldwide. Experts warn that by 2050 AMR could cause an estimated 10 million deaths a year globally, with up to two million of those in India. To better track this threat, researchers analysed wastewater from Delhi, Mumbai, Kolkata and Chennai.
The team collected 447 samples from 19 sites between 2022 and 2024 and applied shotgun metagenomic sequencing to map microbial communities, resistance genes and mobile genetic elements that can spread resistance. They found an abundance of resistance genes across the cities. Although overall bacterial populations varied, many resistance genes were similar, indicating common resistance mechanisms. The study noted Klebsiella pneumoniae was more common in Chennai and Mumbai, while Pseudomonas aeruginosa dominated in Kolkata, yet resistance patterns remained consistent.
Scientists describe sewage as a critical interface where human activity, antibiotic use and microbial diversity meet. A 2023 study called sewage a "major hotspot" for generating and multiplying drug-resistant bacteria and warned that surface water interaction can transmit resistant bacteria to people and animals. Experts point to high and often unregulated antibiotic consumption and untreated wastewater as major contributors.
Policy responses include a One Health approach and the 2025 National Action Plan on AMR, which emphasises wastewater surveillance as a cost-effective way to map community trends. The Indian Council of Medical Research plans to expand surveillance to 50 cities after a pilot in five cities. The NAP lists six strategic priorities such as improving awareness, strengthening surveillance and optimising antimicrobial use. Critics, including Mohit Nair and others, say the plan is often more aspirational than operational and point to weak enforcement, limited state budgets, poor multisectoral coordination and insufficient integration of AMR into programmes for diseases like tuberculosis and HIV. Some experts recommend following local models such as the Kerala State Action Plan.
Difficult words
- antimicrobial resistance — Ability of microbes to survive drug treatment
- wastewater — Water that goes down drains and toilets
- metagenomic — Study of genetic material from environmental samples
- mobile genetic element — Segment of DNA that moves between bacteriamobile genetic elements
- surveillance — Systematic monitoring to detect and measure trends
- hotspot — Place where a problem happens often
Tip: hover, focus or tap highlighted words in the article to see quick definitions while you read or listen.
Discussion questions
- How could wastewater surveillance help public health in your city? Give two reasons based on the article.
- Which challenge listed in the article (for example weak enforcement or limited budgets) seems most serious for implementing the National Action Plan, and why?
- What local steps could reduce the spread of antimicrobial resistance related to antibiotics and wastewater? Give concrete examples.
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