Combating Antibiotic Resistance in Philippine Lakes: One Health upstream interventions to reduce the burden

Lakes provide essential natural resources for populations in low-middle income countries. A growing concern has been contamination with antimicrobial resistance (AMR) determinants from animal and human sources, especially beta-lactams and carbapenems that are the cornerstone of human antimicrobial therapy. A growing literature supports that beta-lactam resistance in Asian lakes and rivers is increasing. However, few interventions have been evaluated to see if environmental contamination from hospitals and agriculture can be reduced. We propose to develop interventions and evaluate their impact on AMR from humans, animals and the environment. Interventions include antimicrobial stewardship programs in hospitals and backyard farms, campaigns to educate the public on AMR, improve management practices on farms and cleaning of effluents feeding the lake. AMR in human and veterinary setting and lake water will be evaluated using conventional microbiology and molecular biology methods. The conditions in and around Laguna Lake in the Philippines resemble those of many Asian, Latin American and African countries, allowing project results to be generalizable to other LMICs and promote the UN sustainable development goals worldwide. The One Health approach is essential to tackle AMR in the human-animal-environment interface. Lower pollution loads will improve water quality and lake resources, and reduce disease outbreaks, benefiting the Laguna lakeshore communities of over 16 million people.