Antimicrobial Stewardship in Hospitals, Resistance Selection and Transfer in a One Health Context





Research Project: 2022-02-14 - 2025-02-13
Total sum awarded: €1 489 864

Our STRESST project (Antimicrobial Stewardship in Hospitals, Resistance Selection and Transfer in a One Health Context) will determine the effects of hospital-wide antimicrobial stewardship on the amount of antibiotics, and the numbers of susceptible and resistant bacteria, released in hospital wastewater. This data will show if stewardship can reduce the amounts of antibiotics and resistant bacteria entering the environment. Hospital wastewater is also likely to represent a hotspot for selection of antibiotic resistant bacteria. We will determine if the antibiotics present can catalyse both intracellular transposition and intercellular conjugation of mobile genetic elements carrying antibiotic resistance genes, and if this is less likely to occur following the antimicrobial stewardship intervention. In addition to agar plate-based assays, these experiments will also include state of the art animal caecum fermenter models which will directly link the healthcare environment (hospital) with the wider environment (via hospital wastewater) and animal health representing all three One Health areas. Ultimately, the STRESST project will demonstrate the effectiveness of antimicrobial stewardship in reducing antibiotic, and antibiotic resistant bacteria, release into the environment and how this impacts resistance transmission within and between microbial communities present in animals that use this as a water source. This holistic view of resistance transmission within a One Health context will serve to highlight a selection hotspot (hospital wastewater) for future interventions.

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  • Adam Roberts, Liverpool School of Tropical Medicine, United Kingdom (Coordinator)
  • Andrew Singer, UK Centre for Ecology & Hydrology, United Kingdom (Partner)
  • Nina Langeland, University of Bergen, Norway (Partner)
  • Michael Brouwer, Wageningen University & Research, Netherlands (Partner)

The transfer of antibiotic residues and antibiotic resistant bacteria into the environment and subsequently in animal drinking water may have an effect on the transmission of resistant bacteria and their resistance genes back into the human population. This holistic One Health view of antibiotic resistance is at the heart of our project. We want to determine if hospital wide antimicrobial stewardship implementation will reduce antibiotics and antibiotic resistant bacteria from entering the environment and if the reduction of antibiotic concentrations will lower the transfer of resistance genes between bacteria in the environment and in animals. We will show that hospital wastewater is a hotspot for selection of resistance and pave the way for future, targeted interventions aimed at reducing the amounts of antibiotics released into the environment even further.