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Monitoring Cross-Border Dissemination of Antimicrobial Resistance (AMR) via Air Travel to Saudi Arabia: Formulation
Changzhi Wang1,2, Shaman Narayanasamy2, Manal Shaabad3
1Biological and Environmental Science and Engineering Division, King Abdullah University of Science and Technology (KAUST), Thuwal 23955-6900, Kingdom of Saudi Arabia.
Abstract:
Antimicrobial resistance (AMR) is a global health challenge, and its dissemination can be accelerated by international air travel. Aircraft sewage, aggregating microbial material from global travelers, offers a unique surveillance opportunity for AMR at international entry points. However, specific AMR elements detected in aircraft sewage and how their relative abundance and transcriptional activity may be associated with flight characteristics such as flight duration or departure country remain unclear. This study analyzed 130 sewage samples from international flights arriving in Saudi Arabia across 27 countries. Metagenomic analyses revealed distinct AMR profiles in aircraft sewage compared to local municipal sewage, including elevated relative abundances of Enterococcus faecium and Staphylococcus aureus. Aircraft sewage harbored 51 antibiotic resistance genes (ARGs) that were not detected in local municipal sewage, predominantly carbapenem-resistant genes (e.g., blaNDM, blaVIM). Additionally, geographical origin of flights shaped AMR composition with lower ARG diversity observed from African-origin flights, whereas Asian and American flights exhibited enriched ARG profiles. Flight length affected AMR expression with long-haul flights (>3500 km) associated with elevated transcription levels. These findings demonstrated how international air travel facilitates the dissemination of AMR across regions and provided actionable insights to devise aircraft sewage surveillance strategies.
Insights
Aircraft sewage surveillance reveals global antimicrobial resistance (AMR) spread. International flights carry diverse antibiotic resistance genes (ARGs), with long-haul flights showing higher gene activity, highlighting air travel
Area of Science:
- Environmental microbiology
- Public health
- Genomics
Background:
- Antimicrobial resistance (AMR) poses a global health threat, potentially spread by international air travel.
- Aircraft sewage is a rich source of microbial material from diverse global travelers, offering a unique surveillance opportunity.
- Understanding specific AMR elements and their association with flight characteristics is crucial for effective surveillance.
Purpose of the Study:
- To analyze the antimicrobial resistance (AMR) profiles in aircraft sewage.
- To investigate the association between AMR elements and flight characteristics like duration and origin.
- To assess the potential of aircraft sewage as a tool for global AMR surveillance.
Main Methods:
- Metagenomic analysis of 130 sewage samples from international flights arriving in Saudi Arabia.
- Comparison of AMR profiles in aircraft sewage with local municipal sewage.
- Correlation analysis of AMR gene abundance and transcriptional activity with flight duration and departure country.
Main Results:
- Aircraft sewage exhibited distinct AMR profiles, with higher relative abundances of *Enterococcus faecium* and *Staphylococcus aureus* compared to municipal sewage.
- 51 unique antibiotic resistance genes (ARGs), including carbapenem-resistant genes (*bla*NDM, *bla*VIM), were detected in aircraft sewage but not in local sewage.
- Flight origin influenced AMR composition, with African flights showing lower ARG diversity and Asian/American flights showing enriched ARG profiles. Long-haul flights (>3500 km) correlated with elevated ARG transcription levels.
Conclusions:
- International air travel significantly facilitates the dissemination of AMR across geographical regions.
- Aircraft sewage surveillance can provide valuable insights into the global spread of AMR.
- Findings support the development of aircraft sewage monitoring strategies for early detection of AMR threats at international entry points.
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