Towards Developing an International Environmental AMR Surveillance Strategy




Research Network: 2019-01-01 - 2020-11-30
Total sum awarded: €50 000

There is an urgent and increasing need to fully understand the development and transmission of AMR both into and within the wider environment. However, at present, research into environmental aspects of AMR has been largely confined to individual institutions or academic laboratories. National governments and international bodies (EU, UN, WHO) have recognised that we must establish effective environmental surveillance systems to identify and monitor AMR in our waters, soils, air and wildlife in order to increase understanding of the natural environment’s role in emergence and spread of AMR and how the introduction of antimicrobials/resistant microorganisms from human/animal sources into the environment contribute to AMR. A One Health approach promotes harmonised surveillance across human, veterinary and food sectors and the use of common outcome indicators to monitor AMR and antimicrobial use: several joint national reports publish AMR trends for key indicator bacteria and key antibiotics (for example UK One Health report, DANMAP and Scottish One Health Antimicrobial Usage and Antimicrobial Resistance Report (SONAAR). However, there is no clear consensus so far regarding which indicators to measure for the environmental sector. Therefore, this network aims to identify robust, measurable surveillance indicators and methodologies for environmental AMR by: •Building on and transferring existing knowledge from clinical and animal AMR indicators and methodologies in the context of a multi-sectorial, One Health approach. •Bringing together key researchers with policy makers and regulators across the environmental, human health and veterinary sector and from countries with a wide range of economic settings. •Arrive at a standardised set of targets and reproducible, accessible methodologies allowing comparative data to be generated in a coordinated manner. Setting out our findings in advice and briefings to governments and international bodies.

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  • William Gaze, University of Exeter, United Kingdom (Coordinator)
  • Anne Ingeborg Myhr, GenØk-Centre for Biosafety, Norway (Observer)
  • Gargi Singh, Indian Institute of Technology, India (Observer)
  • Ngo Thi Hoa, Oxford University Clinical Research Unit, Vietnam (Observer)
  • Pascal Simonet, Ecole Centrale de Lyon (ECL), France (Observer)
  • Celia Manaia, Catholic University of Portugal, Portugal (Observer)
  • Dearbhaile Morris, National University of Ireland Galway, Ireland (Observer)
  • Alwyn Hart, Air, Land and Water Research for the Environment Agency, United Kingdom (Observer)
  • Geoffrey Foster, Scotland's Rural College, United Kingdom (Observer)
  • Berit Muller-Pebody, Public Health England, United Kingdom (Observer)
  • Ana Vidal, Veterinary Medicines Directorate, United Kingdom (Observer)
  • Carmen Torres, University of La Rioja, Spain (Observer)
  • Muna Anjum, Animal and Plant Health Agency, United Kingdom (Observer)
  • Elizabeth Wellington, University of Warwick, United Kingdom (Observer)
  • Andrew Singer, Centre for Ecology and Hydrology, United Kingdom (Observer)
  • David Verner Jeffreys, Centre for Environment Fisheries and Aquaculture Sciences, United Kingdom (Observer)
  • Hanan Balkhy, King Saud bin Abdulaziz University, Saudi Arabia (Observer)
  • Martin Antonio, MRC Fajara Campus, Gambia (Observer)
  • Sabiha Yusuf Essack, University of KwaZulu-Natal, South Africa (Observer)
  • Rebecaa Irwin, Public Health Agency of Canada, Canada (Observer)
  • Edward Topp, Agriculture and Agri-Food Canada, Canada (Observer)
  • Tom Wiklund, Åbo Akademi University, Finland (Observer)
  • Joakim Larsson, University of Gothenburg, Sweden (Observer)

Antimicrobial resistant (AMR) infections are predicted to be the leading cause of death by 2050, with a substantial proportion of these caused by AMR bacterial pathogens. The JPIAMR environmental AMR surveillance network brought together 23 partners from 15 countries to discuss the need for, and necessary approaches to implement a surveillance programme. The network included cross sectoral involvement spanning human, animal and environmental regulators and policy makers. Why is the environment important when considering AMR human infections when there is so much focus on reducing antimicrobial usage and improving infection control in hospitals? The answer is because AMR is not a modern phenomenon, and it is much more complex than many people believe. Firstly, it must be recognised that for most of life on earth, the only life was microbial. This means that bacteria are hugely diverse having evolved over billions of years, producing millions of species resulting in a biomass many times greater than all the animals on earth. Just as we obtained our first antimicrobial drugs, such as penicillin, from environmental microorganisms, diverse AMR mechanisms have evolved in environmental bacteria over evolutionary time. Now, antimicrobial usage for treating infections in humans and for treating and preventing disease in livestock has accelerated the rate of AMR evolution in human and animal microbiomes. This has led to the discharge of AMR bacteria and antimicrobial residues to the natural environment through human and animal waste, where they mix with environmental bacteria allowing transfer of resistance mechanisms through a process known as horizontal gene transfer. This network has produced a report highlighting why environmental AMR surveillance is important and which methods are appropriate to generate data on AMR in the complex microbial communities present in soil and aquatic ecosystems. Current understanding of AMR in human bacterial pathogens is largely based on methods which are unable to capture the "gene flow" of antimicrobial resistance genes between bacteria and between environmental, animal and human microbiomes. Comprehensive environmental surveillance data can be used to better understand, and mitigate, the emergence of new resistance mechanisms in human pathogens that originate in environmental microbial communities. It can also be used to inform risk of human exposure to, and transmission of, AMR bacteria from the environment to humans. Appropriate environmental AMR surveillance is an integral part of tackling the global rise in AMR bacterial (and fungal) infections as the data can be used to underpin changes in policy and regulation driving interventions to mitigate the rate at which AMR evolves and spreads across the globe.