Thus, establishing surveillance techniques for monitoring environmental AMR and residual antimicrobials, and
actually conducting fact-finding studies are important and it is vital to conduct risk assessments based on both the
findings from these studies and literature reviews concerning environmental AMR. To set out the evidence
concerning environmental AMR overseas, the research group translated the report Initiatives for Addressing
Antimicrobial Resistance in the Environment: Current Situation and Challenges (2018) into Japanese.[7] Its key
points regarding measures to combat environmental AMR are as follows. 1) If waste is not treated properly, the
environment could be contaminated with antimicrobials and resistant bacteria. 2) The relationship between
antimicrobials, resistant bacteria, and waste in the environment and their impact on human health are not well
understood. 3) Scientific evidence shows that the risk of infection increases as a result of exposure to resistant
bacteria in environmental waters due to the dispersal of antimicrobials and antimicrobial resistance factors into
the environment. 4) The amount of resistant bacteria present in environmental waters and their locations will be
assessed to understand the risks posed by resistant bacteria to human health. 5) The report also cites the need to
assess sampling and testing methods for measuring resistant bacteria in environmental waters and to standardize
practices.
In the area of health care associated infections, field epidemiology and molecular epidemiological analysis of
isolated strains have, thus far, been used for identifying modes of transmission and quantifying the risk of health
effects. However, as described above, research findings indicating that antimicrobial-resistant bacteria derived
from the environment affect human and animal health are scarce. Overseas, as the contamination of vegetables
believed to result from the use of river water for irrigation [8] and assessments of the risk of exposure through
water-based recreation [9] are starting to be reported, albeit only little by little, the risk cycle is being calculated
to a certain degree. At this point, it is difficult to set definite standards for discussing environmental risk. However,
it is vital to quantitatively monitor and evaluate environmental AMR, conduct research that could assist in
appraising health risks, and undertake risk assessments and reviews of major literature from both within Japan and
overseas, as shedding light on the major factors contributing to the environmental AMR load and investigating
whether it is developing into a risk to human and animal health are matters of urgency.

58