Wastewater surveillance for AMR is an emerging field with growing global adoption. Several countries and research consortia are developing environmental AMR monitoring frameworks to complement clinical surveillance systems.

Current global efforts focus on:

• Mapping environmental resistomes
• Monitoring resistance gene abundance
• Tracking high-risk pathogens
• Linking antibiotic consumption to resistance
• Evaluating wastewater treatment effectiveness
• Building early warning systems

India represents a critical setting for wastewater-based AMR surveillance due to:

• High antibiotic consumption
• Dense urban populations
• Mixed sanitation infrastructure
• Environmental antibiotic contamination
• High AMR burden