A One Health approach for monitoring antimicrobial resistance: Developing a national freshwater pilot effort

Antimicrobial resistance (AMR) is a global public health threat causing 10 million deaths by 2050. The National Antimicrobial Resistance Monitoring System (NARMS) monitors AMR in retail meats, humans, and food animals since the mid-1990s. Since 2020, the U.S. Environmental Protection Agency has implemented a surface water AMR monitoring program (SWAM) at watershed and national scales. The SWAM data will help develop robust monitoring programs, assess public health risks, and understand the spatial and temporal relationships of resistant strains within watersheds.