ArticleNature communications2019
Global monitoring of antimicrobial resistance based on metagenomics analyses of urban sewage.
Article in Nature communications, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 504 papers, 2 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
504 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Wild birds as environmental reservoirs of antimicrobial-resistantFrontiers in microbiology · 2026Pooled it
- The neglected model validation of antimicrobial resistance transmission models - a systematic review.Antimicrobial resistance and infection control · 2025Pooled it
- Water, sanitation, handwashing, and nutritional interventions can reduce child antibiotic use: evidence from Bangladesh and Kenya.Nature communications · 2025Trial
- Global transmission dynamics of antibiotic resistance genes: Foodborne pathways as the critical link to humans.One health (Amsterdam, Netherlands) · 2026Article
- Sewage surveillance for assessing clinical antibiotic resistance prevalence: Combining metagenomic and phenotypic data.One health (Amsterdam, Netherlands) · 2026Article
- Isolation and genomic characterization of a Teetrevirus phage infecting Klebsiella quasipneumoniae with a putative SAMase gene.Archives of virology · 2026Article
- Jestvirus, a Novel Genus in the Family Autotranscriptaviridae Infecting Aeromonas.Current microbiology · 2026Article
- Evaluating surface water for genomic surveillance of community-linked antimicrobial resistance in ESBL-producingEnvironmental advances · 2026Article
- Review
- Building-Scale Wastewater Metagenomics Reveals Temporal Patterns in Resistance and Virulence Genes.Antibiotics (Basel, Switzerland) · 2026Article
- Aircraft Wastewater as a Sentinel for Transboundary Antimicrobial Resistance: An Integrated Genomic Approach.Microorganisms · 2026Article
- metaWEPP: leveraging biobank-scale intra-species phylogenies for near-haplotype resolution in metagenomic analysis.NAR genomics and bioinformatics · 2026Article
- AResKGLM: a graph-grounded language-model framework for interpretable multi-hop antimicrobial resistance reasoning.Briefings in bioinformatics · 2026Article
- Sarand: exploring antimicrobial resistance gene neighbourhoods in complex metagenomic assembly graphs.NAR genomics and bioinformatics · 2026Article
- Wastewater Metagenomic Surveillance Reveals Socioeconomic Patterns of Pathogen Diversity and Antimicrobial Resistance in Nairobi, Kenya.Antibiotics (Basel, Switzerland) · 2026Article
- Integrated qPCR and Shotgun Metagenomics for Surveillance of Antimicrobial Resistance in Municipal Wastewater from Central Italy.Antibiotics (Basel, Switzerland) · 2026Article
- The COVID-19 pandemic influenced the temporal dynamics of antimicrobial resistance markers and bacterial community across urban wastewater treatment plants.Brazilian journal of microbiology : [publication of the Brazilian Society for Microbiology] · 2026Article
- Plasmid-mediated antimicrobial resistance across One Health sectors: transmission dynamics and surveillance needs.mSphere · 2026Review
- City-scale resistome-mobilome architecture and mobility-associated ARG backbones across a megacity watershed.iScience · 2026Article
- Computational Genomics for Resistome Characterization: Current Advancements and Future Challenges Under a One Health Perspective.Antibiotics (Basel, Switzerland) · 2026Review
444 more citing papers are in PubMed but not listed here.
Corrections and comments
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Authors and funding
34 authors.
Funding
Abstract
Antimicrobial resistance (AMR) is a serious threat to global public health, but obtaining representative data on AMR for healthy human populations is difficult. Here, we use metagenomic analysis of untreated sewage to characterize the bacterial resistome from 79 sites in 60 countries. We find systematic differences in abundance and diversity of AMR genes between Europe/North-America/Oceania and Africa/Asia/South-America. Antimicrobial use data and bacterial taxonomy only explains a minor part of the AMR variation that we observe. We find no evidence for cross-selection between antimicrobial classes, or for effect of air travel between sites. However, AMR gene abundance strongly correlates with socio-economic, health and environmental factors, which we use to predict AMR gene abundances in all countries in the world. Our findings suggest that global AMR gene diversity and abundance vary by region, and that improving sanitation and health could potentially limit the global burden of AMR. We propose metagenomic analysis of sewage as an ethically acceptable and economically feasible approach for continuous global surveillance and prediction of AMR.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.