Degradation profiles of antibiotics within on-site sanitation

Introduction: Increasing rates of antimicrobial resistance (AMR) is a pressing global public health problem of the 21st century; the emergence and dissemination of resistance poses a growing threat to the treatment of many common infectious diseases (Bhatia and Narain, 2010). The evolution and transmission of resistant bacteria is affected by the environmental conditions in which they are found; their environment has the ability to act as both a dispersal route and a reservoir of resistant microbials (Larsson et al., 2018). One large environmental pressure is caused by the release and disposal of antimicrobials through sanitation infrastructure, comprising of antibiotic metabolites digested by humans and the disposal of antibiotics (Prestinaci, Pezzotti and Pantosti, 2015). In order to understand antimicrobial resistance, research is needed to identify and quantify these areas of manmade antibiotic pressures, in turn informing ongoing research and technical solutions (Laxminarayan et al., 2013). Currently there is research ongoing into the removal of antibiotics and resistance within wastewater treatment plants, mostly focused in high-income countries. However, this research is not applicable to on-site sanitation, which is used by 3.1 billion people globally, predominantly in developing countries (JMP, 2019). Due to the high prevalence of on-site sanitation in developing countries combined with their increased susceptibility to high levels of resistant microbials, it is important to establish the potential environmental pressure caused by antimicrobials and resistant genes in on-site sanitation. Therefore, through looking at how antibiotics degrade in on-site sanitation it will be possible to quantify and understand their potential role in increasing antibiotic presence in the environment.
Aims and Objectives: The aim of this research is to establish the degradation profile of key antibiotics within an on-site sanitation system under various conditions. This research can then be applicable in looking at how sanitation and the disposal of antibiotics and their metabolites could be a driver in the development of antibiotic resistance, especially within developing countries.
The research objectives are to identify key indicator antibiotics and establish, through both modelled laboratory tests and field tests, how these antibiotics degrade under a range of conditions within on-site sanitation. This data can then be used to create a systems model for use in further research and policy decisions.
Research Questions:
-To what extent do antibiotics degrade within on-site sanitation and what is their degradation profile?
-How do changes in key on-site sanitation characteristics and environmental conditions affect antibiotic degradation?
-Is on-site sanitation infrastructure an 'antibiotic hotspot' and do they have the potential to contribute towards the development of antibiotic resistance?
Research Need:
The research will be interdisciplinary utilising skills from chemistry and microbiology as well as being in collaboration with the school of geography. The outcomes of the research are envisaged to be used in further research as the field of antibiotic resistance and WASH is relatively new and under researched. There may be some social science and policy impacts of the research outcomes.
There has been a call for research into the contribution of water and sanitation systems to increasing antimicrobial resistance and WHO (World Health Organisation) have identified the need for research 'to identify and quantify the sources, occurrence and transport of antibiotics within environmental media' in their briefing note for antimicrobial resistance as an emerging water, sanitation and hygiene issue. Currently the relative importance of faecal waste / water / sanitation systems as antibiotic reservoirs remains unknown. The proposed research works towards EPSRC's goals in Water Engineering.

Water-WISER will train a cohort of 50 British research engineers and scientists and equip them to work in challenging environments both in the low-income settings of rapidly growing poor cities and in the changing urban environment of the UK, Europe and other regions with a historic endowment of aging infrastructure. The vision is for a generation of engineers with the skills to deliver the trans-disciplinary innovations needed to ensure that future water, waste and sanitation infrastructure is resilient to the stresses posed by rapid urbanisation, global climate change and increasingly extreme natural and man-made disasters. Our alumni will address the urgent need to re-imagine urban spaces as net contributors to ecological and environmental well-being rather than being net users of vital resources such as energy, nitrogen, phosphorus and carbon. These new leaders will be an essential resource if the UK is to deliver on its commitment to the United Nations' Sustainable Development Goals (SDGs), particularly SDG 6 which calls for universal access to safely managed water and sanitation services, within planetary and local ecological boundaries. This next generation of research engineers will enable UK-based engineering consultancies, manufacturers, and utility companies to grow their share of the expanding global market for water and waste services, for example; in the water services industry from 3% to 10% (an increase of £33 billion per annum) by 2030, and attract significant inward investment.
The research which Water-WISER cohorts enable will form the basis of new innovations in the design and delivery of resilient infrastructure and services. Innovations developed by Water-WISER graduates will inform how growing cities are designed and built in the global south and will be used to inform the re-engineering and replacement of the aging infrastructure on which the UK's water and waste services are currently reliant. Our alumni will form the new generation of leaders who will play a central role in securing a larger share of the international water and waste management consultancy market to UK consultancies. The network of expertise and skills created by Water-WISER will enhance potential for collaborations between major UK players (for example strengthening links between UK consultancy, the Department for International Development, and leading UK water agencies such as WaterAid and Water and Sanitation for the Urban Poor) and between UK companies and partners in the global south including international investors such as the World Bank, European Investment Bank, African Development Bank, Asian Development Bank, Inter-American Development Bank and the International Finance Corporation. Graduates of Water-WISER will enter industry, academia and development agencies having spent a substantial period (minimum of six months) embedded in an industry or development partner organisation delivering their field-based research. Water-WISER students will thus gain a unique combination of trans-disciplinary training, field experience and cohort networking; they are destined for leadership roles in UK and international engineering and development consultancies, academia, international development banks, international agencies such as the United Nations and international non-governmental organisations.