African communities have a high prevalence of antimicrobial-resistant bacterial carriage, alongside high levels of antibiotic usage and environmental pollution. Limited access to water, sanitation and hygiene infrastructure and wastewater treatment facilities enables the dissemination of resistant bacteria, antimicrobials and antibiotic resistance-driving chemicals (ARDCs) into local rivers. Few data exist quantifying the chemical drivers of antimicrobial resistance (AMR) in urban aquatic environments from African settings. In this longitudinal surveillance study, we investigated an urban river network in Blantyre, Malawi over a continuous 12-month period, identifying a broad-range of chemical pollutants, including antibiotics, common pharmaceuticals, agricultural and industrial chemicals and heavy metals. Antimicrobial concentrations were found at levels selective for AMR and ARDCs exhibited seasonal variations, indicating that deficient sanitation infrastructure and anthropogenic factors result in high antibiotic and ARDC levels entering the river systems, which serve as an important ecological niche for the acquisition, maintenance and transmission of AMR.

Centre for Water Sanitation Health and Appropriate Technology Development Polytechnic University of Malawi Blantyre Malawi

David Price Evans Infectious Disease and Global Health Group University of Liverpool Liverpool UK

Department of Analytical Chemistry Faculty of Natural Sciences Comenius University in Bratislava Bratislava Slovak Republic

Department of Civil and Environmental Engineering University of Strathclyde Glasgow UK

Department of Clinical Sciences Liverpool School of Tropical Medicine Liverpool UK

Department of Tropical Disease Biology Liverpool School of Tropical Medicine Liverpool UK

Faculty of Fisheries and Protection of Waters University of South Bohemia in České Budějovice South Bohemian Research Center of Aquaculture and Biodiversity of Hydrocenoses Vodňany Czech Republic

Malawi Liverpool Wellcome Program Kamuzu University of Health Sciences Blantyre Malawi

The School of Medicine University of St Andrews St Andrews UK

UK Centre for Ecology and Hydrology Wallingford UK

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Kimera, Z. I., Mshana, S. E., Rweyemamu, M. M., Mboera, L. E. G. & Matee, M. I. N. Antimicrobial use and resistance in food-producing animals and the environment: an African perspective. PubMed PMC

Van, T. T. H., Yidana, Z., Smooker, P. M. & Coloe, P. J. Antibiotic use in food animals worldwide, with a focus on Africa: pluses and minuses. PubMed

Naghavi, M. et al. Global burden of bacterial antimicrobial resistance 1990–2021: a systematic analysis with forecasts to 2050. PubMed PMC

O’neill, J. Tackling drug-resistant infections globally: final report and recommendations.

Antimicrobial Resistance Collaborators Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis. PubMed PMC

Cassini, A. et al. Attributable deaths and disability-adjusted life-years caused by infections with antibiotic-resistant bacteria in the EU and the European Economic Area in 2015: a population-level modelling analysis. PubMed PMC

Lowder, S. K., Skoet, J. & Raney, T. The number, size, and distribution of farms, smallholder farms, and family farms worldwide.

Larsson, D. G. J. & Flach, C. F. Antibiotic resistance in the environment. PubMed PMC

Barathe, P., Kaur, K., Reddy, S., Shriram, V. & Kumar, V. Antibiotic pollution and associated antimicrobial resistance in the environment.

Singer, A. C., Shaw, H., Rhodes, V. & Hart, A. Review of antimicrobial resistance in the environment and its relevance to environmental regulators. PubMed PMC

Singer, A. C., Xu, Q. & Keller, V. D. J. Translating antibiotic prescribing into antibiotic resistance in the environment: a hazard characterisation case study. PubMed PMC

Polianciuc, S. I., Gurzau, A. E., Kiss, B., Stefan, M. G. & Loghin, F. Antibiotics in the environment: causes and consequences. PubMed PMC

Murray, L. M. et al. Co-selection for antibiotic resistance by environmental contaminants. PubMed PMC

Tell, J. et al. Science-based targets for antibiotics in receiving waters from pharmaceutical manufacturing operations. PubMed PMC

Grenni, P., Ancona, V. & Barra Caracciolo, A. Ecological effects of antibiotics on natural ecosystems: a review.

McEwen, S. A. & Collignon, P. J. Antimicrobial Resistance: a One Health Perspective. PubMed PMC

Hinton, R. G. K. et al. Mixed method analysis of anthropogenic groundwater contamination of drinking water sources in Malawi. PubMed

Cocker, D. et al. Investigating One Health risks for human colonisation with extended spectrum β-lactamase-producing Escherichia coli and Klebsiella pneumoniae in Malawian households: a longitudinal cohort study. PubMed PMC

WHO/UNICEF Joint Monitoring Programme for Water Supply, Sanitation and Hygiene. Progress on Sanitation and Hygiene in Africa, 2000–2022. Geneva: World Health Organization (WHO) and United Nations Children’s Fund (UNICEF) (2022). https://www.who.int/publications/m/item/progress-on-sanitation-and-hygiene-in-africa--2000-2022.

Nadimpalli, M. L. et al. Urban informal settlements as hotspots of antimicrobial resistance and the need to curb environmental transmission. PubMed

Bengtsson-Palme, J., Kristiansson, E. & Larsson, D. G. J. Environmental factors influencing the development and spread of antibiotic resistance. PubMed PMC

Manyi-Loh, C., Mamphweli, S., Meyer, E. & Okoh, A. Antibiotic use in agriculture and its consequential resistance in environmental sources: potential public health implications. PubMed PMC

Li, W. et al. Changing climate and socioeconomic factors contribute to global antimicrobial resistance. PubMed

Wilkinson, J. L. et al. Pharmaceutical pollution of the world’s rivers. PubMed PMC

AMR Industry Alliance. AMR alliance science-based PNEC targets for risk assessments. (2023). https://www.amrindustryalliance.org/wp-content/uploads/2023/02/AMR-Table-1-Update-20230222_corrected.pdf.

Zhou, Q. et al. Total concentrations and sources of heavy metal pollution in global river and lake water bodies from 1972 to 2017.

Munita, J. M. & Arias, C. A. Mechanisms of antibiotic resistance. PubMed PMC

Wu, D. et al. From river to groundwater: antibiotics pollution, resistance prevalence, and source tracking. PubMed

Faleye, A. C., Adegoke, A. A., Ramluckan, K., Bux, F. & Stenström, T. A. Antibiotic residue in the aquatic environment: status in Africa.

MacPherson, E. E. et al. Understanding antimicrobial use in subsistence farmers in Chikwawa District Malawi, implications for public awareness campaigns. PubMed PMC

Dixon, J. et al. Antibiotic stories: a mixed-methods, multi-country analysis of household antibiotic use in Malawi, Uganda and Zimbabwe. PubMed PMC

Ministry of Health Malawi. Malawi population-based hiv impact assessment 2020–2021: mphia 2020–2021. Final report. Lilongwe, Malawi, Ministry of Health, 10.1016/s2352-3018(23)00144-3 (Lancet HIV) (2022).

Feasey, H. R. A. et al. Prevalence of bacteriologically-confirmed pulmonary tuberculosis in urban Blantyre, Malawi 2019–20: Substantial decline compared to 2013–14 national survey. PubMed PMC

MacPherson, E. E. et al. Household antibiotic use in Malawi: a cross-sectional survey from urban and peri-urban Blantyre. PubMed PMC

Sibande, G. T., Banda, N. P. K., Moya, T., Siwinda, S. & Lester, R. Antibiotic guideline adherence by Clinicians in medical wards at Queen Elizabeth Central Hospital (QECH), Blantyre Malawi. PubMed PMC

Musicha, P. et al. Time to define One Health approaches to tackling antimicrobial resistance. PubMed PMC

Ripanda, A. et al. Ecological consequences of antibiotics pollution in sub-Saharan Africa: understanding sources, pathways, and potential implications.

Mwapasa, T. et al. Key environmental exposure pathways to antimicrobial resistant bacteria in southern Malawi: a SaniPath approach. PubMed PMC

Chidziwisano, K., et al. Risk Perception and Psychosocial Factors Influencing Exposure to Antimicrobial Resistance through Environmental Pathways in Malawi. PubMed PMC

Musicha, P. et al. One Health in Eastern Africa: No barriers for ESBL producing E. coli transmission or independent antimicrobial resistance gene flow across ecological compartments. bioRxiv 2024.09.18.613694. https://www.biorxiv.org/content/10.1101/2024.09.18.613694v1 (2024). DOI

Pang, S., et al. Seasonal differences, source, and fate of Antibiotics in a plain river network-informed watershed.

Kumwenda, S., Tsakama, M., Kalulu, K. & Kambala, C. Determination of biological, physical and chemical pollutants in Mudi River, Blantyre, Malawi.

Schreinemachers, P. & Tipraqsa, P. Agricultural pesticides and land use intensification in high, middle and low income countries.

Murray, A. K. et al. A critical meta-analysis of predicted no effect concentrations for antimicrobial resistance selection in the environment. PubMed

Murray, L. M. et al. Co-selection for antibiotic resistance by environmental contaminants. PubMed PMC

Vrana, B. et al. An interlaboratory study on passive sampling of emerging water pollutants.

Vrana, B. et al. In situ calibration of polar organic chemical integrative sampler (POCIS) for monitoring of pharmaceuticals in surface waters. PubMed

Cocker, D. et al. Drivers of Resistance in Uganda and Malawi (DRUM): a protocol for the evaluation of One-Health drivers of Extended Spectrum Beta Lactamase (ESBL) resistance in Low-Middle Income Countries (LMICs). PubMed PMC

Fedorova, G., Golovko, O., Randak, T. & Grabic, R. Passive sampling of perfluorinated acids and sulfonates using polar organic chemical integrative samplers. PubMed

Grabic, R., Fick, J., Lindberg, R. H., Fedorova, G. & Tysklind, M. Multi-residue method for trace level determination of pharmaceuticals in environmental samples using liquid chromatography coupled to triple quadrupole mass spectrometry. PubMed

Nováková, P., Švecová, H., Borík, A. & Grabic, R. Novel nontarget LC-HRMS-based approaches for evaluation of drinking water treatment. PubMed PMC

R Core Team. R: A Language and Environment for Statistical Computing. R Foundation for Statistical Computing, Vienna, Austria. https://www.R-project.org/. (2024).

Fick, J., Lindberg, R. H., Tysklind, M. & Larsson, D. G. J. Predicted critical environmental concentrations for 500 pharmaceuticals. PubMed