Integrative Profiling of Antimicrobial Resistance Risks in a Philippine Peri-Urban Community: Insights From Clinical Data, Wastewater Analysis and Community Engagement.

Antimicrobial resistance (AMR) is a growing global health threat, particularly in low- and middle-income countries such as the Philippines, where limited resources and regulatory challenges heighten the risk. Community-level assessments are critical for developing a context-specific evidence base that informs local decision-making. This study assessed the community AMR risk in a peri-urban community (Mandug, Davao City, Philippines) using an integrated approach that combined wastewater detection of antimicrobial resistance genes (ARGs), community survey and interviews on knowledge, practices, perceived hazards and the capacities of local government and clinical antimicrobial use (AMU). The β-lactam antibiotics, particularly cephalosporins from the nearest tertiary hospital and amoxicillin, commonly used for self-medication and livestock treatment, were identified as widely available in the area. These findings were supported by wastewater surveillance conducted at three sampling sites that represent Mandug's primary land use patterns: residential, agricultural and mixed-use areas. Quantitative polymerase chain reaction (qPCR) analysis detected multiple ARGs in both residential and agricultural wastewater samples, with blatTEM, blaSHV and aac(6')-lb-cr more prevalent in domestic use, and ermB, aac(6')-lb-cr and tet genes in agricultural areas. Multinomial regression analysis suggests that domestic ARG sources in Mandug may contribute more significantly to community wastewater ARG abundance than agricultural and commercial sources. The community survey indicated moderate knowledge of antibiotics, and existing knowledge gaps may contribute to unsafe practices like self-medication and the indiscriminate use of antimicrobials. Despite basic health infrastructure, factors such as population growth, backyard farming and insufficient implementation of national AMR policies increase vulnerability to AMR threats. Addressing AMR effectively requires a community-centered, multidimensional One Health approach. Priorities include building local capacity, executing targeted public education campaigns, strengthening surveillance systems and enforcing local policy reforms within the local government unit.