The Peril in the Pipes: The Prevalence of ARGs in Wastewater

Nepal's struggle with antibiotic resistance is compounded by its burgeoning urban populations and inadequate wastewater management. Metagenomic analysis of water samples from various sources, including rivers, hospitals, and a wastewater treatment plant in the Kathmandu Valley, has revealed a startling prevalence of ARGs. The study, conducted over three years, detected ARGs such as sul1, tet(B), blaNDM-1, and others, at alarming concentrations of up to 12.2 log10 copies/L in wastewater influents (1).

Hospitals: A Hotbed for Resistance

The study highlighted hospitals as significant contributors to this crisis. High concentrations of blaNDM-1, a gene conferring resistance to last-resort antibiotics, were found in hospital effluents. This finding is particularly concerning given the gene's association with pathogens responsible for hospital-acquired infections. The research underscores the need for robust wastewater management in healthcare facilities to curb the dissemination of these dangerous genes.

Wastewater Treatment Plants: Inadequate Guardians

Wastewater treatment plants (WWTPs), meant to be the bulwark against environmental contamination, are falling short in their role. The study demonstrated that while biological treatment processes like oxidation ditches can reduce the load of ARGs, they do not eliminate them entirely. Genes such as sul1 and intI1, indicative of the spread of resistance, were persistently detected in treated effluents, signaling a clear need for technological upgrades in these facilities.

 Metagenomics: A Powerful Ally

The use of metagenomic techniques studies has been pivotal. By analyzing the entirety of genetic material in the samples, metagenomics offers a comprehensive view of the microbial community and its resistance traits. This holistic approach not only identifies the types of ARGs present but also provides insights into their abundance and diversity, information crucial for devising effective strategies to combat this growing threat.

 The Road Ahead: Policies and Practices

The findings from these studies are a call to action. Policymakers and health practitioners in Nepal must prioritize the development of advanced wastewater treatment technologies and enforce stricter antibiotic usage regulations. Moreover, continuous environmental surveillance using metagenomic methods is essential to monitor and mitigate the spread of antibiotic resistance.

Conclusion: A Global Challenge with Local Solutions

As antibiotic resistance continues to pose a significant threat to public health, the insights from these studies in Nepal offer valuable lessons for the global community. They highlight the necessity of integrating advanced scientific techniques like metagenomics with robust public health policies to tackle this looming crisis. In the heart of Nepal, the battle against antibiotic resistance is not just a local concern but a part of the global effort to preserve the efficacy of life-saving drugs for future generations.

References:

1. Thakali, O., Malla, B., Tandukar, S., Sthapit, N., Raya, S., Furukawa, T., ... & Haramoto, E. (2021). Release of antibiotic-resistance genes from hospitals and a wastewater treatment plant in the kathmandu valley, Nepal. Water, 13(19), 2733.
2. Thakali, O., Tandukar, S., Brooks, J. P., Sherchan, S. P., Sherchand, J. B., & Haramoto, E. (2020). The occurrence of antibiotic resistance genes in an Urban River in Nepal. Water, 12(2), 450.
3. Gautam, B., Rajbhanshi, A., & Adhikari, R. (2019). Bacterial load reduction in Guheswori Sewage treatment plant, Kathmandu, Nepal. Journal of College of Medical Sciences-Nepal, 15(1), 40-44.