Does AMR surveillance of surface water reflect AMR in humans? A genomic comparison of ESBL-producing Escherichia coli from surface water, healthy residents, and a clinical facility.

Surface water ESBL-producing Escherichia coli largely reflects human-associated AMR, with shared lineages and resistance genes, but does not fully mirror clinical populations.

• Why it matters: Effective AMR surveillance is limited in low- and middle-income countries lacking wastewater infrastructure, creating a need for alternative methods to monitor resistance in communities.
• What they did: During an eight-month study in South Africa, 95 ESBL-Ec isolates from surface water, healthy residents, and a clinical facility underwent whole-genome sequencing to analyze resistance and virulence genes, phylogroups, and sequence types.
• The result: Surface water isolates shared several clinically important lineages, including ST131, and resistance genes like bla CTX-M-15, with greater similarity to healthy resident isolates than to clinical isolates, supporting surface water monitoring as a useful complementary AMR surveillance tool.