Building bridges to operationalize One Health — A longitudinal two years’ AMR study in England using clinical and wastewater-based surveillance

The COVID-19 pandemic impacted antimicrobial resistance (AMR) in clinical settings, but evidence is lacking. Considering this, we evaluated community-wide AMR in the shadow of COVID-19, using wastewater-based epidemiology (WBE). 590 wastewater samples were collected from four contrasting communities in England between April 2020 and March 2022 to test for antibiotics used, their metabolites and persistent antibiotic resistance genes (ARGs). Catchment wide COVID-19 cases and antibiotic prescription data were triangulated with WBE data to evaluate impact of COVID-19 pandemic on changes in antibiotics use and resulting AMR at fine spatio-temporal resolution. Observed reduction in antibiotic consumption and AMR prevalence during COVID pandemic (especially during lockdowns) is likely due to reduced social interactions rather than due to reduced antibiotic prescribing. This has significant implications for practice and policy that currently focusses on the reduction of antibiotics as the key risk factor in AMR. Better, more holistic strategies encompassing One Health philosophy are needed to understand and act upon the AMR challenge.