Improving the TRIcycle protocol: upscaling to national Monitoring, detection of CPE and WGS pipelines for One Health Surveillance



Research Project: 2020-02-01 - 2024-07-31
Total sum awarded: €1 085 471

Since 2015, under the auspices of WHO, a basic protocol for One Health Surveillance of AMR has been established. This “Tricycle” protocol integrates human, animal and environmental surveillance and focuses on a single indicator for AMR: ESBL-producing E. coli. To our knowledge, this is the first One Health AMR surveillance protocol that has consistently been piloted across six different countries across the world. The TRIuMPH project builds on the Tricycle project and on the JPI network “NETESE” by adding new research elements and protocols, thereby extending the application of the Tricycle surveillance. This will be achieved in a collaborative approach with current Tricycle and NETESE partners (PK, MY and MG) and partners that contributed to the Tricycle protocol development (UU, RIVM and INSERM). New One Health protocols will be developed and applied in a one year surveillance campaign for the detection of carbapenemase-producing Enterobacteriaceae (CPE, WP2), and for whole genome sequencing analysis of ESBL / CPE isolates (WP3). Within one single country, extension of surveillance to a broader scale is needed, as analyses are currently limited to single cities. This will be brought about by two activities: Inclusion of additional sites within participating countries through in-country training (WP4), and integration with existing monitoring campaigns, such as for water samples taken within the Polio Eradication campaign (WP5). These also offer the opportunity to validate the applicability of wastewater sampling as proxy of community prevalence of ESBL and CPE.

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  • Heike Schmitt, National Institute for Public Health and the Environment (RIVM), Netherlands (Coordinator)
  • Laurence Armand-Lefevre, University Paris-Diderot Medical School, INSERM, France (Partner)
  • Luc Samison, University of Antananarivo, Madagascar (Partner)
  • Rohaidah Hashim, Institute for Medical Research, Malaysia (Partner)
  • Jaap Wagenaar, Utrecht University, Netherlands (Partner)
  • Muhammad Salman, National Institute of Health (NIH), Pakistan (Partner)

Antibiotic resistance circulates in humans, and also in animals and the environment. Knowledge on the presence of resistant bacteria in all three domains is therefore needed to combat the adverse health effects of antibiotic resistance. However, there is little guidance on how to achieve such a One Health surveillance. In the TRIuMPH project, protocols are established to monitor the presence of carbapenemase producing Enterobacterales (CPE), which are particularly concerning antibiotic resistant bacteria. These protocols are applicable to humans, animals and the environment, and can be used globally. These protocols are then implemented and tested in Madagascar, Malaysia, and Pakistan. Next to CPE, ESBL producing E. coli are also analysed using the WHO Tricycle protocol. With whole genome sequencing, the relation between strains found in the three domains will be explored based on openly available tools. Further, extension of current wastewater based surveillance systems to include analysis of resistant bacteria will be tested. These activities help to identify success factors for implementation of One Health surveillance.