MONITORING ANTIMICROBIAL RESISTANCE AND CLIMATE-SENSITIVE INFECTIOUS AGENTS THROUGH WASTEWATER SURVEILLANCE IN URBAN SETTINGS OF WAH CANTT, PAKISTAN

Abstract

Background: Antimicrobial resistance (AMR) and climate-sensitive infectious agents pose major global health threats, particularly in low- and middle-income countries. Wastewater surveillance offers a promising approach for detecting emerging pathogens and monitoring AMR trends at the community level. Despite growing evidence worldwide, there is limited research from Pakistan on the environmental prevalence of AMR genes and climate-sensitive pathogens through wastewater monitoring. Objectives: This study aimed to (1) determine the prevalence and types of antimicrobial resistance genes in wastewater samples from Wah Cantt, Pakistan; (2) identify and describe the occurrence of climate-sensitive infectious agents such as Vibrio spp., dengue viral RNA, and fungal spores; and (3) explore associations between environmental factors and the occurrence of AMR genes and climate-sensitive pathogens. Methods: A quantitative descriptive cross-sectional study was conducted using wastewater samples collected from urban sites in Wah Cantt. Molecular detection techniques, including polymerase chain reaction (PCR) and quantitative PCR (qPCR), were employed to identify AMR genes and climate-sensitive pathogens. Environmental factors such as temperature, rainfall, and pH were recorded. Data analysis was performed using descriptive statistics, chi-square tests, and logistic regression to assess associations between environmental variables and microbial prevalence. Results: A total of 60 wastewater samples were analyzed. High prevalence of AMR genes, including blaCTX-M, blaNDM-1, and tetM, was detected, with multidrug resistance patterns observed across several samples. Climate-sensitive pathogens such as Vibrio cholerae (22%), dengue viral RNA (15%), and fungal spores (18%) were identified. Statistically significant associations were found between rainfall and the detection of Vibrio spp. (p < 0.05), and between higher temperatures and increased AMR gene prevalence (p < 0.05). Conclusion: This study demonstrates that wastewater in Wah Cantt contains a considerable burden of AMR genes and climate-sensitive infectious agents, highlighting the potential of wastewater surveillance as an early warning tool for community-level health risks. Findings underscore the urgent need for strengthened wastewater management, stricter antibiotic regulation, and integration of environmental surveillance into national infectious disease monitoring systems.