Evaluation of frameworks proposed as protective of antimicrobial resistance propagation in the environment

Antimicrobial resistance (AMR) in the environment is a globally concerning issue. This study sought to improve the understanding of human health risks from an environmental AMR proliferation perspective. Surface water concentrations of 11 most used antibiotics in the United States were simulated for the Columbia and Sacramento River watersheds using the Pharmaceutical Assessment and Transport Evaluation (PhATE) model. The predicted environmental concentrations (PECs) and literature-reported measured environmental concentrations (MECs) of antibiotics were compared to the predicted no effect concentrations (PNECs) of three frameworks proposed as protective of AMR selection. For all of the studied antibiotics, PECs (except for moxifloxacin, a 4th generation fluoroquinolone), and at least one published MEC, were above the safe limit proposed by at least one of the three frameworks. The results indicate that a variety of different antibiotics with different mechanisms of action and physico-chemical properties are likely in environmental compartments at or above the concentrations currently proposed as safe from an AMR proliferation perspective. Understanding environmental occurrence of antibiotics is important for assessing environmental exposures and, when compared to PNECs for resistance selection, can-either alone or in combination with other methods- more specifically indicate where there are potential risks of AMR proliferation.