Wastewater treatment plants as critical reservoirs for resistance genes (Gene-gas)

Multiresistant bacteria are a severe problem to modern healthcare. The problem is increasing and development of novel technologies to cope with this critical situation is a necessity. Solutions include novel antibiotic drugs as well as reducing the spread of resistance genes in the environment.

Ongoing project

Wastewater treatment plants (WWTP) are nodal points where much of the contaminated material is passing. When processing the sludge, biogas is produced, followed by a residue, biofertilizer. Sanitation of biofertilizer is usually performed via treatment at 70°C for 1 hour. However, other strategies need to be developed to assure that the frequency of resistance genes in the sludge is drastically reduced.So far, very few reports are present on the abundance of resistance genes, and even less information is available concerning possible treatments to reduce the content.

The present program addresses both of these aspects, the frequency and means to reduce resistance genes by e.g. converting the nucleic acids into biogas. The project involves monitoring of the fate of resistance genes, both in the conventional processing in WWTPs and in subsequent anaerobic digestion. An organism carrying a reporter gene will be added to a model of a WWTP, and the “survival” of that gene will be monitored. Based on the results obtained, a model will be developed concerning the effect of new treatment methods and their impact on spreading of resistance genes. Both bacteria and bacteriophages are carrying resistance genes, and will be monitored to evaluate the effect of different treatments.

Project partners

  • Rolf Lood, Lund University, Sweden (Coordinator)
  • Bo Mattiasson, Lund University, Sweden
  • Kurt Fuurstedt, Statens Serum Institute, Denmark
  • Roald Kommedal, University of Stavanger, Norway

Antimicrobial resistance is a worldwide problem, and many bacteria have now developed resistance towards even last-resort antibiotics. Despite significant attempts to limit this development more and more infections are identified as resistant to the treatment in hospitals. Much effort has been put into understanding the spread of resistance, and treatment thereof, within a hospital setting. It is only quite recently that an understanding that we need to also take in the environment, and development of resistance in such a setting in what now is called a One Health Approach has dawned.

Not only is the presence of resistance in hospitals important, but of equal importance is the presence of free antibiotics in nature, usage of antibiotics for food industry, handling of wastewater etc for the spread of antibiotic resistance. The wastewater treatment plants have been shown to be a hotspot for development of antibiotic resistance due to the high
prevalence of bacteria and viruses there, as well as high levels of antibiotics. This will favor resistant bacteria, and exchange of resistance between microbes. A key player in this perspective are the bacterial viruses (bacteriophages) that can act as a transmission vehicle and transfer resistance between different bacteria. Our research aims at understanding the mechanisms underlying these transmission dynamics, and develop means to limit it.

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Understanding and modelling reservoirs, vehicles and transmission of ESBL-producing Enterobacteriaceae in the community and long term care facilities (MODERN)

The continuing spread of extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBLPE) is among the most important problems in antimicrobial resistance. It is also a good model to investigate the epidemiological complexity of resistance in Enterobacteriaceae.

Ongoing project

Available data on the transmission determinants of ESBL-PE in community settings are scarce, methodologically limited and mostly based on single centre studies. A comprehensive investigation using present typing and modelling techniques is warranted to develop a sound quantitative understanding of the interactions involved. A consortium of investigators with diverse expertise from countries with high and low endemicity of ESBL-EP has been created. Transmission and persistence of ESBL-PE within households and longterm care facilities will be studied. Individual and group-level determinants for transmission and persistence will be quantified, together with other ecological variables including environmental, food and wastewater contamination. Advanced molecular typing techniques and state of the art analytical methods will be used.

Data generated in this project will directly inform a suite of mathematical models which, in addition to encapsulating current understanding of the processes, will be used to explore the potential effectiveness of different interventions to control ESBL-PE spread. The expected outputs are a comprehensive characterisation of ESBL-PE transmission considering bacterial clones and mobile genetic elements, as well as individual and ecologic-level factors in different settings, to inform public health authorities about interventions that shouldbe prioritised to control transmission of these organisms.

Project partners

  • Jesús Rodríguez-Baño, Hospital Universitario Virgen Macarena, Spain (Coordinator)
  • Evelina Tacconelli, University Hospital Tübingen, Germany
  • Stephan Harbarth, University of Geneva, Switzerland
  • Jan Kluytmans, University Medical Center Utrecht, Netherlands
  • Didier Hocquet, University Hospital, France
  • Ben Cooper, University of Oxford, United Kingdom

MODERN is an international collaborative project investigating the reservoirs and transmission of Enterobacteriaceae producing extended-spectrum β-lactamases, a group of antibiotic-resistant bacteria that has spread worldwide recently. The study is centered in transmission in non-hospital environment such as households and nursing homes, and include food products, environmental reservoirs and wastewater. Advanced epidemiological methods and whole genome sequencing are being used to identify the rate and risk factors for transmission of these bacteria among residents in these environments in order to produce the information needed to build mathematical models explaining their spread, which will allow to estimate the impact of potential control measures.

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Dynamics of Antimicrobial Resistance in the Urban Water Cycle in Europe (DARWIN)

While therapeutic antibiotic use directly impacts the evolution of AntiMicrobial Resistance (AMR), it has become increasingly clear that the environmental dimension of AMR is also of great importance.

Ongoing project

We postulate that urban water systems (UWS), which are our receptacle for excreted antimicrobials, AMR organisms and AMR genes, are central conduits of AMR to and from pathogens and environmental strains. This is because of high microbial densities and the co-mingling of different wastes, which promotes accelerated AMR gene transfer (HGT) and multi-resistance due to the cooccurrence of antibiotics, biocides, metals and microbes.

In DARWIN, we will undertake a never-previously-performed pan-European examination of the fate of key AMR organisms and genetic determinants in UWSs resulting from discharged hospital and community wastes, including transmission mechanisms in different stages of sewer catchments and receiving waters. We focus on the spread of AMR genes encoding clinically relevant extended spectrum β-lactam (ESBL) and carbapenem resistance in three countries with differing AMR profiles and sewage management practices. We postulate that AMR genes readily transmit in UWSs from pathogens and commensal hosts in human wastes (after antibiotic use) to environmental strains better adapted to migrate through the sewer environment, which is driven by local ecologies, conjugal plasmid transfer and phage-mediated transduction. Hence, we will, for the first time, determine specific bacterial hosts that carry AMR genes across UWSs, and identify where key HGT events occur with the ultimate goal of assessing the relative risk of AMR genes returning back to humans due to environmental exposure. To guide risk assessments, a predictive dynamic mathematical model for UWSs will bedeveloped to assist in health and sewage management decisions.

Project partners

  • Barth Smets, Technical University of Denmark, Denmark (Coordinator)
  • Søren Johannes Sørensen, University of Copenhagen, Denmark
  • David Graham, Newcastle University, United Kingdom
  • Jan-Ulrich Kreft, University of Birmingham, United Kingdom
  • Jesús L. Romalde, Universidade de Santiago de Compostela, Spain
  • Carlos García-Riestra, University Hospital Complex of Santiago de Compostela – CHUS (Carlos GarcíaRiestra), Spain
  • Mical Paul, Technion Israel Institute of Technology, Israel

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Antibiotic Resistance in Wastewater: Transmission Risks for Employees and Residents around Waste Water Treatment Plants (AWARE-WWTP)

The rise of antibiotic resistant infections is an imminent global public health threat, and mitigation measures are required to minimize the risks of transmission and human exposure.

Ongoing project

Municipal wastewater treatment plants (WWTPs) are known hotspots for the dissemination of clinically relevant resistant bacteria of human origin to the environment, and simultaneously represent targets for intervention and mitigation strategies. While aerosolized bacteria are found within WWTP, it is largely unknown whether WWTP workers are at risk of elevated resistance carriage. In order to study the occupational and environmental transmission of antibiotic resistance due to human exposure to WWTP-borne bacteria, we will assess carriage of extended-spectrum betalactamase (ESBL) and carbapenemase-producing Enterobacteriaceae and resistance genes in WWTP workers, in residents in the proximity of treatment plants, and in water and air samples – both in countries with low and high antimicrobial resistance (AMR).

Based on microbial cultivation as well as on high-throughput sequencing data and quantitative real-time polymerase chain reaction (qPCR), exposure through ingestion and inhalation will be modelled, and airborne exposure will be derived from geospatial analyses. Further, we will analyse treatment efficiencies of different WWTP processes in terms of AMR reduction, and therewith identify science-based critical control points for interventions.

The focus of this transnational collaboration combining complementary and synergistic European research strengths, is to tackle the increasingly relevant public health threats from antibiotic resistance in WWTP by identifying transmission routes, means of exposure, and proposing risk reduction measures.

Project partners

  • Heike Schmitt, National Institute for Public Health and the Environment (RIVM), Netherlands (Coordinator)
  • Carmen Chifiriuc, University of Bucharest, Romania
  • Joakim Larsson, University of Gothenburg, Sweden
  • Katja Radon, Ludwig-Maximilians-Universität, Germany
  • Susan Pettersson, Water and Health, Australia
  • Kate Medlicott, World Health Organization (WHO), Switzerland
  • Peter Ulleryd, Västra Götaland och Regionala Strama Södra Älvsborgs Sjukhus, Sweden

The rise of antibiotic resistant infections is a global public health threat. Municipal wastewater treatment plants (WWTPs) are known hotspots for the spread of antibiotic resistant bacteria to the environment, and also represent targets for interventions. It is largely unknown whether WWTP workers are at risk of elevated carriage of antibiotic resistant bacteria.

In order to address the transmission of antibiotic resistance in WWTPs, the JPI project AWARE assesses specific resistant bacteria (ESBL and carbapenemase-producing Enterobacteriaceae) as well as antibiotic cresistance genes in WWTP workers, in residents in the proximity of treatment plants, and in water and air samples. These are studied in countries with low and high antimicrobial resistance (AMR). Based on microbial cultivation as well as on molecular microbiological analyses, human exposure is modelled. Treatment efficiencies of different WWTP are determined.

This transnational European collaboration combines complementary and synergistic research strengths, and tackles the public health threats from antibiotic resistance in WWTP by identifying transmission routes, means of exposure, and proposing risk reduction measures.

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Selection and Transmission of Antimicrobial Resistance in Complex Systems (STARCS)

Selection and transmission are key determinants for the dissemination of antimicrobial resistance (AMR) across the planet. These determinants of AMR are frequently studied in laboratory settings while in reality they occur in complex systems, e.g. in microbial communities that colonize human and animal guts or in environmental ecosystems.

Ongoing project

The central aim of STARCS (Selection and Transmission of Antimicrobial Resistance in Complex Systems) is to characterize and quantify the processes of selection and transmission of AMR genes and drug-resistant bacteria in complex (eco)systems from a ‘One Health’ perspective and to integrate these elements into predictive mathematical models, which will be used to inform policy development.

To reach this goal, the consortium will (i) develop and implement innovative metagenomics methodologies to map the expression of AMR genes and their linkage to bacterial hosts and mobile genetic elements in human, animal and environmental samples, (ii) use relevant animal models (using mice and ducks) and observational studies (in hospitals and in dogs and their owners) to analyse and quantify the processes of selection and transmission of drug-resistant Enterobacteriaceae (specifically Extended Spectrum Beta-Lactamase producing Escherichia coli) and (iii) implement state-of-the-art epidemiological modelling to quantify the spread of ESBL-producing E. coli between humans and animals. STARCS will develop technological breakthroughs to assess selection and transmission dynamics on the level of the resistance gene, the mobile genetic element, the bacterium, the humananimalenvironment interface and in clinical settings.

This project will deliver important knowledge into selection and transmission of AMR, will provide the scientific community with novel tools to study selection and transfer of AMR in complex systems and will result in much-needed guidance towards policy decisions by international and national institutions. Ultimately the results from STARCS will form an evidence-based foundation for the development of new regulations, aimed at curbing the spread of AMR

Project partners

  • Rob Willems, University Medical Center Utrecht, Netherlands (Coordinator)
  • Dik Mevius, Wageningen University & Research, Netherlands
  • Dan Andersson, Uppsala University, Sweden
  • Teresa M Coque, Ramón y Cajal University Hospital, Spain
  • Romain Koszul, Pasteur Institute, France
  • Mark Woolhouse, University of Edinburgh, United Kingdom
  • Surbhi Malhotra-Kumar, University of Antwerp, Belgium 

ESBL-producing Enterobacteriaceae (ESBL-PE) are not new, having first been recognised in the 1980s. However, since 2003, the CTX-M type of ESBL have been constantly increasing and rapidly spreading. Most CTX-M-producing Enterobacteriaceae are exceptionally resistant to multiple antibiotics. These include penicillins and cephalosporins, two of the most important and widely used antibiotics. As a result, there are very limited treatment options for mild to moderate infections, which makes it of pivotal importance to control the emergence and spread of ESBL-PE.

In the STARCS project we study he pathways by which resistant bacteria, particularly ESBL-PE, can emerge in complex ecosystems, in which they can acquire genetic material that encodes resistance to antibiotics. To this aim, we have developed a number of tools that are used to characterise the reservoir of resistant bacteria in microbial ecosystems. In addition, we perform research into the transfer of resistant bacteria between animals and humans. Among other things, we study whether resistant bacteria can be transferred between dogs and their owners.

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The rates and routes of transmission of multidrug resistant Klebsiella clones and genes into the clinic from environmental sources (SpARK)

Klebsiella pneumoniae (Kp) is a leading cause of multidrug resistant hospital-acquired infections globally, and is responsible for an increasing public health burden in the community.

Ongoing project

In order to control the spread of Kp through targeted surveillance and intervention policies it is necessary to identify the sources of emergent community and health-care associated infection from the interlinked and varied niches encompassing “the environment”. To address this, we will sample from multiple clinical, community, agricultural, veterinary and environmental settings in and around a single town, Pavia, in Northern Italy, and supplement these data with matched samples from France and elsewhere.

We will use whole genome sequencing of community (mixed-colony) samples to assay accessory gene abundance and distribution. This contrasts with the more common approach based on phylogenetic analysis of single colonies, which would be of limited utility over broad environmental scales due to the complexity of transmission chains, environmental dormancy, and high rates of recombination. In contrast, our gene-centric approach provides a much more efficient means to understand ecological adaptation, the distribution of resistance and virulence genes, and to identify key environmental reservoirs from which clinical clones emerge. A key deliverable of this project will be the establishment of a pan-genome database (‘pangenomium’) that will integrate with both existing Kp genome community resources established by project partners (BIGSdb-kp, and wgsa.net).

Project partners

  • Edward Feil, University of Bath, United Kingdom (Coordinator)
  • Piero Marone, Fondazione IRCCS Policlinico San Matteo, Italy
  • Sylvain Brisse, Pasteur Institute, France
  • Louise Matthews, University of Glasgow, United Kingdom
  • Jukka Corander, University of Oslo, Norway
  • David Aanensen, Big Data Institute, Oxford, United Kingdom
  • Alan McNally, University of Birmingham, United Kingdom

The emergence of antibiotic resistant bacteria represents a severe threat to global public health, and there is an urgent need to identify new strategies to mitigate the spread of these infections. Improved management of antibiotic resistance requires deep knowledge of both the evolution and ecology of these pathogens. The use of antibiotics in agriculture and aquaculture means that environmental niches can act as incubators for the emergence of new resistant strains. It is therefore critical that we understand how these bacteria adapt and survive under many different and varied conditions, including in soil, in water and in animals.

The aim of this project is to identify the environmental settings which pose the gravest risk to public health, with respect to the emergence of antibiotic resistance. We target a group of closely related bacterial species called Klebsiella, which includes the species K. pneumoniae. This species is one of the most common infectious agents in hospitals, and has acquired resistance to a wide range of antibiotics. We have sampled thousands of Klebsiella strains from humans, animals, soil and water in and around a single town, Pavia, in northern Italy. By applying modern genome sequencing techniques to these strains, we will begin to understand where in the environment new resistant bacteria might be evolving, and how they spread from one place to another, which will ultimately help to manage their spread.

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Genomic approach to transmission and compartmentalization of extended-spectrum cephalosporin resistance in Enterobacteriaceae from animals and humans (TransComp-ESC-R)

Resistance to extended-spectrum cephalosporins (ESC) in Enterobacteriaceae is a major challenge for public health worldwide. Its international presence in almost every ecological niche and biological compartment with still ongoing dynamic expansion makes it an ideal target to study the spread of AMR.

Ongoing project

This project intends to use genomic, evolutionary, transcriptomics, proteomics and experimental approaches to assess the similarities between a variety of ecological niches and biological compartments formed by Enterobacteriaceae species, host species/source (humans, dogs, cattle, swine, chicken, meat products) and geography (Europe: Germany and France, and North America: Canada). These similarities will serve as a basis to identify and focus further on clonal lineages and plasmids able to spread across compartments, using whole genome and plasmid sequencing.

A combination of phylogenetic and epidemiologic analyses will allow an assessment of the directionality of transmission between compartments. These analyses will be complemented by series of experiments on transmission of ESC resistance plasmids in vivo in two animal models (chicken and cattle) and on effects of ESC resistance plasmids on the bacterial transcriptome and proteome and its association with plasmid maintenance. These experiments will help to identify major transmission pathways between animals and humans and potential new intervention targets for the control of ESC resistance.

The team assembled for this project consists of experienced researchers with a wide spectrum of expertise ideal for the successful completion of a study of antimicrobial resistance in the context of One Health.

Project partners

  • Patrick Boerlin, University of Guelph, Canada (Coordinator)
  • Richard Bonnet, Université d’Auvergne, France
  • Jean-Yves Madec, National Agency for Food, Environmental and Occupational Health & Safety (ANSES), France
  • Michael Mulvey, University of Manitoba, Canada
  • Stefan Schwarz, Friedrich-Loeffler-Institut, Germany
  • James Wood, University of Cambridge, United Kingdom
  • Alison Mather, University of Cambridge, United Kingdom
  • Heike Kaspar, Federal Office of Consumer Protection and Food Safety, Germany

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Escherichia coli ST131: a model for high-risk transmission dynamics of antimicrobial resistance (ST 131_transmission)

This project will connect a large number of transnational academic resources to investigate the transmission success of Escherichia coli ST131 clone. E. coli is the most common cause of urinary tract and bloodstream infections worldwide. A recent WHO report states that resistance to one of the most widely used antibiotics (fluoroquinolones [FQs]) is very widespread.

Ongoing project

In many parts of the world, FQs are now ineffective in more than half of patients. A single E. coli clone, ST131, is predominantly responsible for this global FQ-R and cephalosporin-R pandemic causing millions of antibioticresistant infections annually. It remains unclear which features of ST131 had resulted in the biggest antimicrobial resistance succes of the 2000s.

We propose a combined European-Canadian consortium that will investigate the transmission dynamics of ST131. This study will explore the vertical and horizontal transmission of resistance and virulence genes and how they contributed to the transmission success of ST131 among humans, animals and different environments. The broad goal is to improve human health by better understanding managing infections due to multidrug resistant E. coli. The study will explore explanations for the high transmission rates and success of ST131.

A famous quote from Stephen Hawking; “Intelligence is the ability to adapt to change”. ST131 adapted rapidly to environmental changes; we need to know why and how. This project will serve as a model to predict what can possibly happen in the future with the continuing emergence of multidrug resistant clones among bacteria.

Project partners

  • Johan Pitout,University of Calgary, Canada (Coordinator)
  • Neil Woodford, ARHI-UK, United Kingdom
  • Fernando Baquero, Ramón y Cajal Institute for Health Research (IRYCIS), Spain
  • Marie-Hélène Nicolas-Chanoine, Beaujon Hospital/ Paris VII University, France
  • Laurent Poirel, University of Fribourg, Switzerland
  • Alvaro Pascual, Fundación Púbica para la Gestión de la Investigación de Salud en Sevilla, Spain
  • Jean-Yves Madec, National Agency for Food, Environmental and Occupational Health & Safety (ANSES), France
  • Tarah Lynch, University of Calgary, Canada

E. coli is the most common cause of urinary tract and bloodstream infections worldwide. A recent WHO report states that resistance to one of the most widely used antibiotics (i.e. fluoroquinolones [FQs]) for the treatment of infections caused by E. coli is very widespread. In the 1980s, when the FQs were first introduced, resistance (R) was virtually zero. Today, in many parts of the world, FQs are now ineffective in more than half of patients. Of special concern is that FQ-R is often accompanied by resistance to the cephalosporins. A single E. coli clone, ST131, is predominantly responsible for this global FQ-R and cephalosporin-R pandemic causing millions of antibiotic-resistant infections annually. It remains unclear which features of ST131 had resulted in the biggest antimicrobial resistance succes of the 2000s.

We propose a combined European-Canadian consortium that will investigate the transmission dynamics of ST131. This study will explore the vertical and horizontal transmission of resistance and virulence genes and how they contributed to the transmission success of ST131. The project will also investigate transmission of ST131 among humans, animals and different environments. The broad goal is to improve human health by better understanding the spread and managing infections due to multidrug resistant E. coli. The study will use the strengths of the different partners in this consortium to explore explanations for the high transmission rates and success of ST131. Only by understanding how antibiotic resistance evolves and spreads in bacterial populations, can we begin to overcome such resistance.

A famous quote from Stephen Hawking; “Intelligence is the ability to adapt to change”. ST131 adapted rapidly to environmental changes; we need to know why and how. This project will serve as a model to predict what can possibly happen in the future with the continuing emergence of multidrug resistant clones among bacteria.

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Predicting the Persistence of Resistance Across Environments (PREPARE)

Antimicrobial resistance poses a serious challenge to health care worldwide. Attempts to control resistance by stopping antimicrobial use have met with mixed success. Failures of a critical assumption underlying such strategies – that resistant strains suffer a disadvantage in the absence of drug (the “cost of resistance”) – may be responsible for difficulties in controlling resistance by cessation of drug use.

Ongoing project

In particular, resistance mutations may be cost free, and hence persist, in some environments or on some genetic backgrounds. Furthermore, even when resistance is initially costly, compensatory evolution – the accumulation of mutations that restore fitness while maintaining resistance – may allow resistant strains to persist. Using two pathogenic bacterial species, we propose to undertake a systematic study of the costs of resistance across multiple genetic backgrounds, as well as across a variety of relevant conditions across the human-animal-environment axis.

Moreover, we will determine whether resistant pathogens take the same, or different, routes to compensation in different environments. Taking advantage of evolutionary theory, we will determine the feasibility of predicting the costs of resistance in one environment using information from another environment, which would aid in predicting the persistence of resistant strains using limited information from laboratory studies. The proposed work will provide crucial information for public health policy on strategies for controlling resistance.

Project partners

  • Alex Wong, Carleton University, Canada (Coordinator)
  • Claudia Bank, Instituto Gulbenkian de Ciência, Portugal
  • Thomas Bataillon, University of Aarhus, Denmark
  • Isabel Gordo, Instituto Gulbenkian de Ciência, Portugal
  • Rees Kassen, University of Ottawa, Canada

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Risk of companion animal to human transmission of antimicrobial resistance during different types of animal infection (PET-Risk)

The close contact of pets with humans provides excellent opportunities for interspecies transmission of resistant bacteria and their resistance genes in either direction.

Ongoing project

Infections in humans due to antimicrobial resistant bacteria originating from pets are becoming a concern. While any animalhuman contact offers a chance of transmission, it is generally accepted that a high bacterial burden and high antimicrobial resistance gene copy numbers are present during an active infection. There is a gap of knowledge on the dynamics of transmission and selection of antimicrobial resistance at the pethuman interface. Animals may exchange antimicrobial-resistant bacteria and resistance genes with humans, but the extent to which this happens is unknown.

PET-Risk will evaluate the transfer of antimicrobial resistance between pets and household members during animal infections and determine which type of infection (skin and soft tissue vs. urinary tract infections) presents a higher risk of transmission to humans. Furthermore, in a longitudinal study we will collect samples of infected animals under antimicrobial treatment, and their household members at several time points, which will allow the assessment of critical control points at which interventions could substantially affect the spread of resistance. The causality and directionality of pet-human spread of resistance genes will be established by using state-of-the-art techniques in order to design and evaluate preventive and intervening measures for reducing the public health risks of antimicrobial resistance.

Project partners

  • Constança Ferreira Pomba, University of Lisbon, Portugal (Coordinator)
  • Stefan Schwarz, Friedrich-Loeffler-Institut, Germany
  • Scott Weese, Ontario Veterinary College at the University of Guelph, Canada
  • Anette Loeffler, The Royal Veterinary College, United Kingdom
  • Vincent Perreten, University of Bern, Switzerland

The close contact of companion animals with humans provides excellent opportunities for interspecies transmission of resistant bacteria and their resistance genes in either direction. There is a gap of knowledge on the dynamics of transmission and selection of antimicrobial resistance at the companion animal-human interface.

Pet-Risk is evaluating the transfer of antimicrobial resistance between companion animals and household members during animal active infections and determine which type of infection (skin and soft tissue vs urinary tract infections) promotes a higher risk of transmission of antimicrobial resistance to humans. We already know that sick animals in contact with humans tend to favour colonization by resistant bacteria in both species. The first report of a OXA-181 E. coli producer in a dog from Portugal and the sharing of ESBL-producing Enterobacteriaceae between humans and pets are already under scrutiny.

Furthermore, preliminary results by rep-PCR seem to point to the detection of some families sharing ESBL-producing Enterobacteriaceae between humans and pets. The causality and directionality of spread of resistance genes between humans and companion animals will be established in order to design and evaluate preventive and intervening measures for controlling resistance and diminishing the public health consequences of antimicrobial resistance.

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