JMIR Publications

ABSTRACT

Background:

Antimicrobial resistance (AMR) is a known global public health threat as well as it brings economic consequences to agriculture. Antibiotic resistance is an interconnection of humans, animals and the environment as proposed in tricycle surveillance by the WHO. In Malaysia, research and surveillance of AMR are mainly derived from clinical samples, agricultural settings, and surface water but none from the drinking water system. Hence, this policy-driven study is a combined effort of microbiologists and engineers to provide baseline data on the magnitude of AMR as a possible pollutant in the drinking water system which is not being monitored at present.

Objective:

This study aims to determine the baseline level of antibiotic resistance in drinking water distribution from pre-and post- drinking water treatment plants (DWTP) in a selected state in Malaysia. Drinking water treatment plants were randomly chosen based on the lists of DWTP in the selected state provided by the authorized stakeholder.

Methods:

This is a lab-based, cross-sectional study in a selected state, Malaysia. Water samples from six drinking water treatment plants (DWTPs) will be collected. Samples will be collected at three sampling points consisting of the intake sampling station, service reservoir outlet station, and distribution system sampling station for seven types of antibiotics in triplicates. Samples will be screened for antibiotic-resistant genes (ARGs) and quantified for the level of antibiotics present in the DWTPs.

Results:

The sampling frame was scheduled starting from November 2021 until November 2022. As of March 2022, we have sampled 4 drinking water treatment plants consisting of the river, post-treatment and main distribution tap. Results will be reported as the prevalence of antibiotic-resistant bacteria in the drinking water system; and the level of antibiotics present in the drinking water system as the primary outcome. As the secondary outcome, bacteria isolated obtained from the primary outcome will be tested whether they are carrying antibiotic-resistant genes in the drinking water system. Descriptive statistics will be performed on the number of bacterial colonies harvested from water samples grown on Reasoner’s (R2A) agar with or without antibiotics, the level of antibiotics detected in water samples, and the occurrence of antibiotic-resistant genes. The expected results will be published end of 2022 to early 2023.

Conclusions:

This study will provide baseline information on the status of antimicrobial-resistant bacteria, the presence of resistance genes as contaminants, and the level of antibiotics present in drinking water systems to support the policymaker to consider AMR as a parameter in drinking water surveillance.