Impact of reducing colistin use on colistin resistance in humans and poultry in Indonesia




Research Project: 2022-01-06 - 2025-05-31
Total sum awarded: €1 040 103

Colistin (polymyxin E) is considered a last resort antimicrobial for treatment of infections with multidrug- resistant bacteria, classified by WHO as ‘highest prioritized, critically important for human medicine’. WHO suggests to ban or highly restrict its use in animals. In Indonesia, colistin resistance in human Escherichia coli isolates is poorly characterized as it requires specific non-routine tests. Presence of colistin resistance in E. coli in poultry resulted in a ban for livestock in Indonesia in 2020. However, colistin is still suspected to be routinely used in humans in multiple settings but the reasons for these practices are poorly understood. The ban on colistin use in livestock offers a unique opportunity to assess the impact of this intervention on colistin resistance in humans and animals, and how a One Health perspective can strengthen this intervention. This project aims to: i) determine phenotypic and genotypic colistin resistance in E. coli from humans and poultry in Indonesia; ii) assess the impact of the colistin ban on resistance in E. coli in animals and humans; iii) estimate the transmission of colistin resistance between animals and humans; iv) study colistin use and perceptions at the community level; and v) expand the initial colistin ban in the animal production sector into an integrative multi-sectorial One Health intervention, which will be designed and implemented using a community participatory approach. This project will provide a strong scientific basis to AMR policies in Indonesia, with great significance across Southeast Asia

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  • Anis Karuniawati, Faculty of Medicine, Universitas Indonesia, Indonesia (Coordinator)
  • Juliëtte Severin, Erasmus MC University Medical Center, Netherlands (Partner)
  • Jaap Wagenaar, Utrecht University, Netherlands (Partner)
  • Sunandar Sunandar, Center for Indonesian Veterinary Analytical Studies, Indonesia (Partner)
  • Herman Barkema, University of Calgary, Canada (Partner)
  • Koen Peeters, Institute of Tropical Medicine, Belgium (Partner)
  • Imron Suandy, Directorate of Veterinary Public Health, DG of Livestock and Animal Health Services, MoA-Indonesia, Indonesia (Observer)

Antimicrobials are drugs that help cure people and animals from infections with bacteria. The slogan: ‘the more you use, the faster you lose’ is definitely applicable for antimicrobials. When you use antimicrobials, more bacteria become resistant, meaning that an infection can no longer be treated. This is a worldwide challenge for the treatment of diseases in animals and humans. The World Health Organization (WHO), like many other organizations, are advocating for reduction of use of antimicrobials when they are not needed. The COINCIDE-project explores what will happen when the use of colistin in animals is banned in Indonesia. Colistin is a specific antimicrobial that is used as last resort in humans if nothing else works, resistance against this antimicrobial means that resistant disease causing bacteria will have free reign. In animals, colistin has been banned in 2020 and a group of human doctors, veterinarians, anthropologists and DNA researchers will look if less bacteria become resistant. We also want to reduce the colistin use in humans, as it is suspected to be used in humans without good reasons. We will work with farmers and their veterinarians, but also with people in the community and doctors and pharmacies to find out why they are still using colistin and if they can do without. The outcome of the project will help governments, farmers, veterinarians, human doctors, and everybody who really needs colistin, to safeguard this antimicrobial for use only when we cannot do without.