Thanks Keith
See the entry I did on this topic some months back.
forum.susana.org/forum/categories?func=v...6&id=2758&limit=1000

Antibiotic-resistant enterobacteria are being spread in sewage systems in India. NDM-1 producing bacteria were found in water supply and sewage seepage samples in New Delhi in a study from May 2011 in The Lancet. Go to above link to get the paper and other reports.

What I find somewhat alarming is that this is being dealt with almost entirely as a medical problem centering on improper use of antibiotics. And the first line solutions remain to be more sophisticated antibiotics. But these are not forthcoming and probably won't be for at least 10 years, if ever. An integrated preventative approach involving water, sanitation and hygiene experts and practitioners has still yet to be initiated. Containment of faeces and reduction of associated pathogens should be the top priority for all cities at risk. Waterborne sanitation systems were never designed to eliminate these sorts of superbacteria and now that they are even turning up in the chlorinated water supply system we can see what sort of monster this can develop into.

See also the ECDC paper from our World Water Week Workshop Sept 2013
programme.worldwaterweek.org/sites/defau..._water_week_2013.pdf

Julius, those are great questions. The reason toxic pollution may increase antibiotic resistance is due to flora shift where sensitive gram-positive bacteria (lactobacillus, bifidobacteria) allow resistant gram-negative bacteria (E. coli, clostridium) to flourish along with rampant, opportunistic fungal overgrowth seen in all major diseases. Indeed, toxic air and soil pollution are both associated with diabetes, but the same cannot be said for sanitation.
www.scientificamerican.com/article.cfm?i...-dirty-soil-diabetes
www.loe.org/shows/segments.html?programI...13-00036&segmentID=3
blogs.windsorstar.com/2013/07/25/study-f...s-related-mortality/
Gut-lung connection is a two-way street: www.scientificamerican.com/article.cfm?i...ole-in-bowel-disease
China leads the world with a fierce diabetes and obesity epidemic because of air pollution, heavy metal pollution in soil and a highly polluted water supply. It's not about white rice and being sedentary. www.ncbi.nlm.nih.gov/pmc/articles/PMC3485276/
www.sciencedaily.com/releases/2013/06/130603092328.htm
news.ku.dk/all_news/2012/2012.9/gut-bact...ould-cause-diabetes/

It's these gram-negative bacteria most associated with antibiotic resistance, so by sheer numbers we're increasing potential to create antibiotic resistant superbugs, see here:
www.ncbi.nlm.nih.gov/pmc/articles/PMC2391261/

Here's an exploration about wastewater treatment plants as major source of antibiotic resistance including references:
www.facebook.com/photo.php?fbid=10153311488915602&l=0f06c38ad0

Amo, thanks so much for asking. Please download the poster linked above where you'll find 96 references. Here it is online, but with watermarks:
f1000.com/posters/browse/summary/1094298

By the way, Sanitation Circle is an organization still forming with goal of promoting dry compost toilet technology. I'm attempting to transition my 25 year career in the recycling industry to sanitation and health. I'm not a trained scientist, more a social technologist with a marketing degree and a keen interest in science. In the 80s I was a UNICEF radio spokesperson for the annual release of State of the World's Children Report, so now marrying interest in environment and health. Here's a recent essay regarding non-communicable diseases (NCDs) and sanitation. Sanitation is not yet on the NCD agenda, a lost opportunity.
www.climateandhealth.org/magazine/read/t...ate--health_289.html

KeithBell wrote: I'm not sure if toxic chemicals and heavy metal pollution is a greater factor than microbial pollution (sewage) in creating antibiotic resistance . . . or if the human gut is a more important reservoir in fostering horizontal gene transfer than wastewater treatment plants.

Could you explain what you mean with the link of toxic chemicals and heavy metals to the creation of antibiotic resistance? I am not aware of any such link and theoretically it doesn't make much sense I think.
Horizontal gene transfer of antibiotic resistance can happen everywhere, but only if there is a sufficient number of vector harboring bacteria and a selection pressure it causes an issue, e.g. only where antibiotics are present in sufficient quantities (human patients, farm animals and habits of the original source organism) a problematically large population of antibiotic resistant bacteria can develop.

KeithBell wrote: But why are UNICEF and the World Bank still building groundwater-polluting pit latrines and wastewater treatment plants? It's time to end the practice of mixing water with waste. Have you heard about the global problem of algae blooms in water fed by nutrients in sewage? Meanwhile, antibiotic resistance genes are studied in the gut microbiota of children:
www.sciencedaily.com/releases/2013/11/131113182425.htm

While I agree that more waste needs to be source separated and recycled, some sort of water borne sewerage makes sense to exist in most cases as water is an important cleaning and hygiene agent.

Hi Keith
Do include links to some of the papers on this topic.
Thanks
--Arno

Today, November 14, is World Diabetes Day.

The global scourge is strongly related to flora shift. Think sensitive gram-positive bacteria (bifidobacteria, lactobacillus) compromised by pollution allowing gram-negatives (resistant e.coli, clostridium) to flourish along with rampant, opportunistic fungal overgrowth.

Here's a Facebook photo devoted to the issue of wastewater treatment as cause of antibiotic resistance due to horizontal gene transfer in microbes. Antibiotic resistance ranks in the top 3 of all health concerns. It's strongly related to flora shift and diabetes.
www.facebook.com/photo.php?fbid=10153311488915602&l=0f06c38ad0

I'm not sure if toxic chemicals and heavy metal pollution is a greater factor than microbial pollution (sewage) in creating antibiotic resistance . . . or if the human gut is a more important reservoir in fostering horizontal gene transfer than wastewater treatment plants.

But why are UNICEF and the World Bank still building groundwater-polluting pit latrines and wastewater treatment plants? It's time to end the practice of mixing water with waste. Have you heard about the global problem of algae blooms in water fed by nutrients in sewage? Meanwhile, antibiotic resistance genes are studied in the gut microbiota of children:
www.sciencedaily.com/releases/2013/11/131113182425.htm

Is anyone considering poor sanitation as cause of the global diabetes epidemic? What about all the other NCDs (non-communicable diseases) such as autism, Alzheimer's, cancer, heart and lung disease?

Evidence is mounting diabetes is a matter of intestinal microbial imbalance. Indeed, all the major NCDs may be explained in this way, gut origin. Gut-brain connection is a very hot topic.

Given the global scourge that is diabetes, this issue alone may be a very powerful way toward improved sanitation, especially dry compost toilet technology.

Meanwhile, sanitation is not on the NCD agenda guided by the UN and WHO, a lost opportunity.

Here's a Facebook photo I've devoted to the issue. Please feel free to send a friend request as sanitation and health are my focus on Facebook:
www.facebook.com/photo.php?fbid=10153499190915602&l=de2edfe628

Also attached is a poster and abstract I recently presented at a health symposium: "Water-­Based Sanitation and Negative Effect on Flora Balance"