Research and analysis

Antimicrobial resistance in bioaerosols: towards a national surveillance strategy - summary

Published 26 October 2023

Applies to England

1. Chief Scientist’s Group report summary

The Environment Agency plays a key role in monitoring air quality across the UK. In this project we reviewed what information is available to inform the design of a monitoring strategy to look for antimicrobial resistant (AMR) microorganisms in the atmosphere. We considered the decisions that must be made in designing such a network, reviewed current knowledge and knowledge gaps, and tested some of the available sampling tools under field conditions to assess their practicality and operating costs.

1.1 Background

Infections that do not respond to treatment with antimicrobial agents such as antibiotics and fungicides are a major global risk that needs to be managed to protect human, animal and plant health. While antimicrobial resistance in clinical settings has received significant attention, less is known about AMR prevalence in the environment. AMR organisms may travel in the air and then contact people and animals and plants.

1.2 Approach

We carried out a Rapid Evidence Review to better understand:

• What AMR genes have been detected in airborne microorganisms and how have these been measured?
• What are typical prevalences of AMR near potential sources or points of human exposure?
• How does the presence of AMR vary from place to place and over time?
• How does airborne AMR in the environment link with occurrence of AMR infections and what is the risk?

Alongside this we considered strategies for surveillance of airborne AMR at potential sources or points of human exposure. We looked at options for sampling equipment, analysis and additional data that would be needed. To explore the practicalities and real-world costs of airborne AMR sampling we carried out some on-site studies.

1.3 Results

The review found that there is evidence of AMR microorganisms in the air near to potential source types, including livestock and arable agriculture, wastewater treatment, and biowaste treatment (such as composting sites).  

Suitable methods were found to exist for sampling airborne microorganisms and analysing for AMR. The precise selection and use of these methods in a monitoring network would depend on the specific objectives of a strategic network, but in pilot studies they were found to be suitable for field use, producing samples suitable for analysis. Preliminary screening indicated that AMR organisms were detectable in a proportion of the samples.

1.4 Conclusions

The project identified methods suitable for sampling airborne microorganisms to capture any that are resistant to one or more antimicrobials in the atmosphere, and these have been costed. However, the authors felt that there is too little data at present to design a surveillance network giving statistically reliable results on likely human exposure. We therefore recommend a staged approach to surveillance development, addressing current knowledge gaps and so ensuring that subsequent design steps can meet their intended purpose.

1.5 Publication details

This summary relates to information from project SC220001, reported in detail in the following output:

• Report: SC220001
• Title: Antimicrobial resistance in bioaerosols: towards a national surveillance strategy
• Project manager: Dr Rob Kinnersley, Chief Scientist’s Group

This project was commissioned by the Environment Agency’s Chief Scientist’s Group, which provides scientific knowledge, tools and techniques to enable us to protect and manage the environment as effectively as possible. This work was carried out as part of the Environment Agency Chief Scientist’s Group research into AMR in the environment and has been funded by the PATH-SAFE programme which has been funded by HM Treasury through the Shared Outcomes Fund.

Enquiries: research@environment-agency.gov.uk.

© Environment Agency