Each year, an estimated 7·7 million deaths are attributed to bacterial infections, of which 4.95 million are associated with drug-resistant pathogens, and 1·27 million are caused by bacterial pathogens resistant to the antibiotics available. Access to effective antibiotics when indicated prolongs life, reduces disability, reduces health-care expenses, and enables access to other life-saving medical innovations. Antimicrobial resistance undoes these benefits and is a major barrier to attainment of the Sustainable Development Goals, including targets for newborn survival, progress on healthy ageing, and alleviation of poverty. Adverse consequences from antimicrobial resistance are seen across the human life course in both health-care-associated and community-associated infections, as well as in animals and the food chain. The small set of effective antibiotics has narrowed, especially in resource-poor settings, and people who are very young, very old, and severely ill are particularly susceptible to resistant infections. This paper, the first in a Series on the challenge of antimicrobial resistance, considers the global scope of the problem and how it should be measured. Robust and actionable data are needed to drive changes and inform effective interventions to contain resistance. Surveillance must cover all geographical regions, minimise biases towards hospital-derived data, and include non-human niches.

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Aerobic granular sludge (AGS) is gaining popularity as an alternative to activated sludge for wastewater treatment. However, little information is available on AGS regarding the removal of organic micropollutants (OMPs) through sorption. In this study, the sorption behavior of 24 OMPs at environmentally relevant concentrations (1 μg/L) was investigated in six sludge fractions of varying sizes (>4 mm, 2–4 mm, 1–2 mm, 0.6–1 mm, 0.2–0.6 mm, and <0.2 mm) from a full-scale AGS reactor using batch experiments. Sorption was significant (removal efficiency >40 %) for 10 OMPs, including 4 zwitterionic and 6 positively charged pharmaceuticals, indicating the importance of electrostatic interaction for OMP sorption in AGS systems. Larger granules exhibited a higher sorption coefficient and capacity than smaller AGS fractions, probably due to increased extracellular polymeric substance content for larger granules. Equilibrium OMP sorption was only reached after 72 h in granules larger than 2 mm, indicating an effect of longer diffusion distance for OMPs into larger granules. Additionally, compared to activated sludge, AGS demonstrates a similar or even slightly higher sorption capacity for 10 OMPs at 1 μg/L. Overall, this study is the first to investigate the sorption behavior of six AGS size fractions for OMPs at environmentally relevant concentrations (1 μg/L) and propose the possible roles of different-sized sludge in OMP sorption in the full-scale AGS reactor.@en

Source-separated gray water reclamation using nanofiltration as an advanced post-treatment option has received substantial interest in meeting the growing water demand. During reclamation, membrane integrity is crucial to ensure the water’s safety. This study evaluated several chemical and novel microbial indicators as indirect membrane integrity-monitoring methods for hollow fiber nanofiltration membranes in reclamation schemes. Under normal conditions, high retention of divalent ions and organic matter and near-complete removal of Escherichia coli (E. coli) were observed. Limited removal of the antibiotic gene (ARG) tetO was observed due to low feed concentrations and a higher detection limit (LOD). While 16S rRNA and ARG sul1 were not limited by their LODs, lower removals were observed, most likely due to free-floating DNA passing through the membranes. A broken fiber in a pilot-scale module reduced organic matter and microorganism removal substantially, while flux and ion rejection remained similar. Predictions made using the observed results and a previously proposed model allowed for the evaluation of the selected methods in upscaled reclamation systems. Based on these results, it was concluded that microorganisms could be employed as indicators in indirect membrane integrity-monitoring methods in large-scale reclamation schemes, while UV_254nm absorbance (used in organic matter determination) could be a viable solution in pilot-scale systems.

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Surveillance of antibiotic resistance genes (ARGs) has been increasingly conducted in environmental sectors to complement the surveys in human and animal sectors under the "One-Health"framework. However, there are substantial challenges in comparing and synthesizing the results of multiple studies that employ different test methods and approaches in bioinformatic analysis. In this article, we consider the commonly used quantification units (ARG copy per cell, ARG copy per genome, ARG density, ARG copy per 16S rRNA gene, RPKM, coverage, PPM, etc.) for profiling ARGs and suggest a universal unit (ARG copy per cell) for reporting such biological measurements of samples and improving the comparability of different surveillance efforts.

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