In 2017, Lubbert et al published this manuscript describing environmental pollution from mass drug manufacturing industries in India. Significant concentrations of well-known anti-infectives such as voriconazole, fluconazole and levofloxacin were recovered in the water surrounding these production facilities. Corresponding microbiological analyses revealed a significant concentration of extended-spectrum beta-lactamase and carbapenemase-producing Enterobacteriaceae and non-fermenter bacteria.
To what extent does environmental contamination of water and food supplies with antimicrobial agents drive global antimicrobial resistance? The answer is not fully known but is neatly explored in this Lancet Infectious Diseases commentary.
Bottom line, as we attempt to get a grasp limiting antimicrobial resistance, our approach must be multi-dimensional. This includes antimicrobial use in both animal and human populations, clinical surveillance mechanisms to monitor resistance patterns, and environmental monitoring. In toto, these elements can better shape and define the policies and practices desperately needed to optimize global antimicrobial stewardship.