A Framework for Antimicrobial Resistance Risk Assessment, Monitoring, and Risk-Reduction Practices along the Reused Water-Soil-Crop-Human Continuum.

Food security in many parts of the world is threatened by reduced water availability, resulting from population growth and climate change. Under these circumstances, irrigating crops with reclaimed water is becoming an increasingly important agricultural practice. A framework is proposed to address these concerns, evaluate how effectively current regulations ensure safe and sustainable water reuse in the context of antimicrobial resistance (AMR), and identify opportunities for more targeted guidance. The paper proposes indicators for water quality assessment that take into account risks specific to AMR and define primary contamination entry points, potential amplification points, and barriers (e.g., contaminant dissipation in soil, delay between irrigation and harvest, postharvest management), along the wastewater-irrigation, water-crop, and production-consumer continuum. In terms of risk management, an overview of the range of water and wastewater treatment options is provided, from secondary sewage treatments to advanced treatments, including weighing the costs and benefits of interventions in the context of local needs and constraints and the availability and quality of alternative irrigation water sources. The recommendations herein were developed through a consensus at an international multidisciplinary expert workshop and literature review.