title: Towards a research agenda for water, sanitation and antimicrobial resistance.
abstract: Clinically relevant antimicrobial resistant bacteria, genetic resistance elements, and antibiotic residues (so-called AMR) from human and animal waste are abundantly present in environmental samples. This presence could lead to human exposure to AMR. In 2015, the World Health Organization (WHO) developed a Global Action Plan for Antimicrobial Resistance with one of its strategic objectives being to strengthen knowledge through surveillance and research. With respect to a strategic research agenda on water, sanitation and hygiene and AMR, WHO organized a workshop to solicit input by scientists and other stakeholders. The workshop resulted in three main conclusions. The first conclusion was that guidance is needed on how to reduce the spread of AMR to humans via the environment and to introduce effective intervention measures. Second, human exposure to AMR via water and its health impact should be investigated and quantified, in order to compare with other human exposure routes, such as direct transmission or via food consumption. Finally, a uniform and global surveillance strategy that complements existing strategies and includes analytical methods that can be used in low-income countries too, is needed to monitor the magnitude and dissemination of AMR.
authors.affiliation: National Institute for Public Health and the Environment (RIVM), P.O. Box 1, 3720 BA Bilthoven, The Netherlands E-mail: ana.maria.de.roda.husman@rivm.nl.
authors.forename: Susanne
authors.initials: S
authors.lastname: Wuijts
authors.affiliation: National Institute for Public Health and the Environment (RIVM), P.O. Box 1, 3720 BA Bilthoven, The Netherlands E-mail: ana.maria.de.roda.husman@rivm.nl.
authors.forename: Harold H J L
authors.initials: HH
authors.lastname: van den Berg
authors.affiliation: Virginia Polytechnic Institute and State University, Blacksburg, VA, USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Miller
authors.affiliation: University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
authors.forename: Lydia
authors.initials: L
authors.lastname: Abebe
authors.affiliation: University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
authors.forename: Mark
authors.initials: M
authors.lastname: Sobsey
authors.affiliation: Diderot Medical School, University of Paris, Paris, France and Bichat Hospital Bacteriology Laboratory, Paris, France.
authors.forename: Antoine
authors.initials: A
authors.lastname: Andremont
authors.affiliation: World Health Organization (WHO), Geneva, Switzerland.
authors.forename: Kate O
authors.initials: KO
authors.lastname: Medlicott
authors.affiliation: National Institute for Public Health and the Environment (RIVM), P.O. Box 1, 3720 BA Bilthoven, The Netherlands E-mail: ana.maria.de.roda.husman@rivm.nl.
authors.forename: Mark W J
authors.initials: MW
authors.lastname: van Passel
authors.affiliation: National Institute for Public Health and the Environment (RIVM), P.O. Box 1, 3720 BA Bilthoven, The Netherlands E-mail: ana.maria.de.roda.husman@rivm.nl; Institute for Risk Assessment Sciences (IRAS) of Utrecht University, Utrecht, The Netherlands.
authors.forename: Ana Maria
authors.initials: AM
authors.lastname: de Roda Husman
mesh_terms: D000890:Anti-Infective Agents / Q000494:pharmacology*; D004352:Drug Resistance, Microbial; D006801:Humans; D012499:Sanitation / Q000592:standards; D014871:Water Microbiology / Q000592:standards; D014944:World Health Organization
chemical_list: D000890:Anti-Infective Agents