Development and validation of hospital wastewater and aquatic environment sampling for sentinel surveillance of antimicrobial resistance
( RESERVOIR )

Carbapenemase-producing Enterobacterales (CPE) and extended spectrum beta-lactamase-producing non-E. coli Enterobacterales (ESBLE) are significant antimicrobial resistance (AMR) threats. Identifying their spread in hospitals is important to guide adequate infection control measures, prevent outbreaks and reduce clinical burden. Conventionally, high-risk patients are screened to assess CPE and ESBLE spread in hospitals, but the methodology varies widely between centres, is costly, uncomfortable for patients, has low detection sensitivity, and overlooks the role of the hospital environment. Alternative surveillance methods could overcome these hurdles and facilitate benchmarking within and between hospitals. In this study we will develop and validate alternative surveillance strategies using regular sampling of the hospital aquatic environment and wastewater for sentinel surveillance of CPE and ESBLE circulation in high-risk wards. The methodology will be validated in four clinical sites with varying endemicity levels and infection control practices. The sites will perform weekly screening of patients, sinks, toilets and wastewater. Whole genome sequencing of positive patient/environmental samples will be applied to better understand transmission dynamics, differentiating between plasmid-mediated transmission and clonal transmission of drug resistance. Additionally, a modelling framework will be developed to assess the relative contribution of the different transmission routes and further support the development of an efficient AMR surveillance strategy.