Infection with resistant bacteria can occur due to various causes. These include exposure to other infected people (for instance due to poor hygiene), but food, contact with animals and environmental factors could also play a role. RIVM investigates various sources and various ways in which resistant bacteria can spread.

Sources such as wastewater and fertiliser generate large flows of bacteria to water, soil and air every year, and some of these bacteria are antibiotic-resistant. Once they have reached the environment, people might come into contact with resistant bacteria by swimming in surface water, for instance. The Ministry of Health, Welfare and Sport commissioned research to explore this issue, in consultation with the Ministries of Infrastructure and Water Management and Economic Affairs.

In collaboration with Wageningen University, RIVM has investigated the possible role played by the environment in spreading antimicrobial resistance to people and potential response measures. A study, recently approved by JPI, will focus on possible risks for employees of sewage purification companies and people living near water processing plants. This study will be conducted in collaboration with partners in Sweden, Germany and Romania. Another JPI project concerns a network of internationally acclaimed researchers from Canada, the United Kingdom, France, the United States and elsewhere, which will calculate the potential public health impact from exposure to antibiotic-resistant bacteria/genes in the environment (including drinking water and bathing water).