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[This article belongs to Volume - 69, Issue - 8]
Published on : 2024-08-10 12:16:15
Article Code: AMJ-10-08-2024-12294
Title : Wastewater Metagenomic Surveillance Predicts Community Emergence of Carbapenem-Resistant Enterobacteriaceae Six Weeks Prior to Clinical Isolation
Author(s) : Dr. Layla Hassan
Abstract :
Antimicrobial resistance (AMR) surveillance relies on clinical cultures, introducing detection delays. We implemented
a longitudinal wastewater metagenomics pipeline across three tertiary hospitals and surrounding communities,
sequencing 200 samples monthly over 18 months. Bioinformatic analysis of resistance genes (ARGs) using deep
learning models (AMR-Guard) predicted the emergence of carbapenem-resistant Enterobacteriaceae (CRE) strains
six weeks before first clinical isolation in 92% of outbreak events. Plasmid-associated blaKPC-3 and blaNDM-1 genes
were detected in wastewater at concentrations as low as 10³ copies/mL, correlating with subsequent patient
colonization. Genomic epidemiology confirmed clonal transmission between wastewater isolates and clinical strains.
This environmental sentinel surveillance system enables preemptive infection control interventions and represents
a paradigm shift from reactive to predictive AMR management.