A new £1.25 million project, which will research the role of managing antibiotic use in combatting AMR transmission, will utilise the novel wastewater sampling technique UKCEH developed in response to the COVID-19 pandemic. This is the first time this technique will be implemented with populations outside the UK, and used to target non-COVID health questions.

It is thought that the transfer of antibiotic residues and antibiotic resistant bacteria into the environment, and subsequently into animal drinking water, may have an effect on the transmission of resistant bacteria and their resistance genes back into the human population. 

Therefore, the project – Antimicrobial Stewardship in Hospitals, Resistance Selection and Transfer in a One Health Context (STRESST) – will determine the effects of hospital-wide antibiotic use programmes on the numbers of susceptible and resistant bacteria in a hospital in Malawi. The goal is to use wastewater surveillance to provide insights into the efficacy of antibiotic management programmes and the control of antimicrobial resistance in patients.

Dr Andrew Singer, principal scientist at UKCEH, said: “We are really excited to be field-testing several next-generation wastewater sampling kits in Malawi to understand the impact of different antibiotic management programmes on the presence of antimicrobial resistance (AMR) in the hospital population.

“The novel sampling technology was developed in response to the need to conduct wastewater-based surveillance in the UK during the COVID-19 pandemic; this will be the first time that it will be implemented to populations outside of the UK and target non-COVID health questions.”

The project is being led by the Liverpool School of Tropical Medicine (LTSM) at the Queen Elizabeth Central Hospital in Blantyre, Malawi and in partnership with Malawi Liverpool Wellcome Trust (MLW). They will work with collaborators at UKCEH, as well as the University of Bergen, Norway and Wageningen Bio-veterinary Research, Netherlands.

Project lead, Dr Adam Roberts, from LSTM, said: “Hospital wastewater is a potential hotspot for selection of resistance and by taking this One Health approach we want to determine if comprehensive and sustained antimicrobial stewardship can reduce antibiotics and antibiotic resistant bacteria from entering the environment and if any reduction of antibiotic concentrations will lower the transfer of resistance genes within and between bacteria in the environment and in animals. By showing this, we will pave the way for future, targeted interventions aimed at reducing, or removing, the amounts of antibiotics released into the environment at this hotspot.”

The £1.25 million funding has been awarded by the Joint Programming Initiative on Antimicrobial Resistance (JPIAMR), 

The STRESST project is set to last three years and builds on developmental work on sewage samplers that Roberts’ team carried out as part of the European Regional Development Fund Project (ERDF) and aligns with the iiCON work strand led by Professor Feasey.