Água, antibióticos e saúde pública

A Professora Célia Manaia, da ESB, é coordenadora do projeto europeu StARE (Stopping Antibiotic Resistance Evolution) que envolve dez parceiros em sete países e pretende contribuir para uma melhor compreensão do cada vez mais grave fenómeno da resistência bacteriana, nomeadamente em águas residuais. Nesse âmbito o programa conjunto europeu sobre água (Water JPI) promoveu uma entrevista onde são exploradas as dimensões técnicas, políticas e sociais deste desafio. A ler abaixo, em inglês.

How dangerous are antibiotics as new water pollutants?

The main concern associated with the antibiotics as water contaminants is the effect they may have on the natural microbial communities and, specifically, the effect that may have on the promotion of antibiotic resistance dissemination. Together with the considerable load of antibiotic residues, also millions of antibiotic resistant bacteria are discharged in the sewers. The problem is that in the presence of such residues, antibiotic resistant bacteria may be stimulated, somehow, to spread antibiotic resistance determinants, being favoured to survive and proliferate when have acquired antibiotic resistance genes. Then, those antibiotic resistant bacteria can be disseminated, through water, to different places, where they will proliferate and give their antibiotic resistance genes to other bacteria. In simple words, a never-ending story that may have already led us to the growing public health threat that we are facing nowadays.


How will the project StARE tackle the water quality challenge?

The World Health Organization has been expressing serious concerns about the growing public health threat that antimicrobial resistance represents. This is a problem without boundaries of any kind, connecting different world regions and crossing different sectors of human activity.

Water is not only an important habitat for bacteria, but also a privileged way for transport of contaminants, including microorganisms and genetic material, from the reservoirs where they are produced; usually areas subjected to strong anthropogenic impacts. Therefore, wastewater plays a pivotal role on the transport of contaminants, including antibiotic resistant bacteria and genes. Numerous studies have shown that the removal of some wastewater contaminants, including antibiotic resistant bacteria and genes, cannot be achieved by the conventional wastewater treatment systems. In addition, except for research purposes, the assessment of the quality of the treated wastewater does not take into account the efficiency of removal of such contaminants. Hence, there is an urgent need in establishing adequate methods to monitor antibiotic resistance in water, and encourage data sharing across different countries and sectors of activity. The efforts made to survey antibiotic resistance in clinical settings in Europe and other world regions had important implications on antibiotic resistance control. It is high time to apply identical strategies to the environment. In parallel, the development of cost-effective processes to reduce antibiotic resistant bacteria from water is a priority. We believe that in this way StARE will contribute to tackling the water quality challenge. 


Which main outcomes do you expect to achieve with your research?

StARE involves two major lines of action - 1) the diagnosis of the status of contamination by antibiotics residues and antibiotic resistance genes in wastewater treatment plants across Europe, focused on partner countries; and 2) the development of advanced wastewater treatment processes efficient for the removal of both antibiotics residues and antibiotic resistance genes to levels at which proliferation would be minimized. One of the problems of some of advanced technologies is that due to the stress conditions imposed to bacteria, antibiotic resistance selection and dissemination can be stimulated. Hence, this is another focus of our research; to assess the potential of some stress factors to enhance the dissemination of antibiotic resistance.

We expect to produce a first overview of the occurrence of antibiotic resistance genes and antibiotic residues in municipal wastewater in countries with different patterns of use of antibiotics and different levels of prevalence of antibiotic resistant bacteria in the clinical settings. This big picture of the antibiotic resistance gene pool in wastewater across Europe may bring interesting insights into the relationship between antibiotic resistance in the environment and in the clinical ambient. And, certainly, it will contribute to improve water treatment in the future.


Have you established links with other initiatives on the same topic?

StARE is integrated in a network of synergic projects and activities that have the potential to enhance the goals and impacts of individual initiatives. For instance, the COST action "New and emerging challenges and opportunities in wastewater reuse" (ESSEM COST Action ES1403, NEREUS), the Working Group 5 on the topic "Wastewater reuse and Contaminants of Emerging Concern" of the NORMAN network, the H2020 MSCA ITN "ANtibioticS and mobile resistance elements in WastEwater Reuse applications: risks and innovative solutions" (ANSWER) are complementary projects coordinated by Dr. Despo Fatta-Kassinos (University of Cyprus) that involve also some of the StARE partners, are now establishing interesting synergies with what we are doing. Another promising partnership is with the project Halting Environmental Antibiotic Resistance Dissemination (HEARD), integrated in the programme Partnerships for International Research and Education  (PIRE) financed by the US National Science Foundation, which is coordinated by Dr. Peter Vikesland of the Virginia Tech, that involves an international committee of researchers from Europe and from Asia. This will be another opportunity to develop harmonized methods and for sharing data at international level. HEARD and StARE are twin projects acting in different world regions. We hope these combined efforts will have significant impacts on the improvement of water quality control, not only on technical aspects but also on policy making.


Which kind of water technologies would be necessary to reduce water contamination?

The answer to this question is one of the expected outcomes of StARE. We believe that the highest the removal of bacteria from wastewater, the better. But it is necessary to assess the risks of advanced treatment processes to select for antibiotic resistant bacteria. This is something that requires further research. 


Are you carrying out communication and dissemination activities to the citizens?

As researchers working in an area that affects directly the quality of life, StARE team members are often involved in activities with diverse public societies, in particular through high schools and the media. We believe that making people aware of these issues is also important to help improve attitudes, behaviors and policies.


Have you read the Strategic Research and Innovation Agenda of the Water JPI?

Yes, with particular attention to the sections more related with my area of research.


Which is your opinion on the alignment of research and innovation fostered by this international initiative in the water sector?

Innovation is a word that is on the agenda in several areas of research. However, depending on the context, its meaning and implications can be different. Unfortunately, this is not always clear. Regarding the water sector, innovation is often associated with technological developments and marketing products. Although this is very important and to be encouraged, the potential conflicts between the economic sector and the management of a natural and life-indispensable resource, as is the case of water, is something that needs to be seriously considered. The alignment of research and innovation towards the achievement of sustainable water use and the availability of good water quality is indeed a major priority of our days and SRIA will be certainly an important contribution to reaching this goal.