Rethinking Antimicrobial Resistance Surveillance

MAGIcIAN, or Modelling Approaches to Guide Intelligent surveillance for the sustainable Introduction of novel Antibiotics, combines clinical, microbiological, epidemiological, and computational modelling expertise to address national and local needs for epidemiological surveillance and ultimately, to support the introduction of novel antimicrobial drugs. Learn more about MAGIcIAN here. 

OASIS addresses the need for epidemiological surveillance within a One Health paradigm, with the aim of making it applicable across high-, middle-, and low-income settings. The goal of the project is to make surveillance easier and more accessible through Lot Quality Assurance Sampling and to help decision-makers act in a timely and well-informed manner. Learn more about OASIS here.  

Held at the historic Les Pensières, the event was lauded a success with around 50 in-person and online participants. Les Pensières provided the participants with heartwarming hospitality and support. As a Centre for Global Health, Les Pensières is a product of the Mérieux foundation and is a space for health practitioners to discuss their findings and to promote knowledge that contributes to public and global health.

The day opened with headlining speaker, Anna Dean, an epidemiologist and veterinarian in the Department of Surveillance, Prevention and Control of AMR at the World Health Organization (WHO) Headquarters in Geneva. She discussed GLASS or the Global AMR Surveillance System. Established in 2015, GLASS was the first global collaborative platform to standardize the collection of information on antimicrobial resistant genes and bacteria. It also marks a significant shift to not merely collect laboratory data but also epidemiological, clinical, and population-based data.

After Anna’s informative session, the OASIS team took the stage to share their experience with the Lot Quality Assurance Sampling method (LQAS) which they used in the project to study AMR prevalence across different settings. Frank van Leth, coordinator of Project OASIS, opened the morning OASIS session describing the LQAS methodology and initial findings of the project. Looking at the test characteristics, LQAS is well suited for several AMR surveillance objectives (providing prevalence, estimates, assessing time trends in prevalence, evaluating impact of interventions). The LQAS method is not suitable as an “early warning system”, given the marked levels of misclassification at low prevalence of AMR.

Maike Richter and Carina Leitner, two PhD candidates from the University of Giessen and Friedrich-Loeffler Institute, proceeded to discuss the results of the surveillance study done in German livestock populations, specifically pigs and chickens. For the LQAS approach to be a feasible method for determining AMR prevalence in this setting, there is need for a careful design of the surveillance approach. The vastly different levels of AMR for the different antibiotics in the veterinary domain, requires setting context-specific LQAS-parameters. 

Abdoul-Salam Ouedraogo and Mounerou Salou, Professors and Researchers from the Nazi Boni University and the University of Lomé, shared and discussed the LQAS-based AMR surveillance in human populations in Burkina Faso and Togo, respectively. The study revealed that the prevalence of AMR was above 20% for E. coli or K. pneumonia cultured from patients with suspected uncomplicated urinary tract infection for a large number of antibiotics in both countries. Given these results, the treatment of these infections would require other than first-line antibiotics.

Finally, to cap off OASIS, Christopher Pell shared the stakeholder perspective on using LQAS as a monitoring system for livestock and human populations. Results from interviews with stakeholders in the human domain showed little awareness of AMR surveillance strategies, but the use of LQAS was seen as potential feasible. Stakeholders in the veterinary domain expressed their worries that additional AMR surveillance strategies would lead to a more restrictive approach to antibiotic use, thereby threatening animal welfare. Abuse, misuse, and overuse of antibiotics is prevalent in both humans and livestock and the hope of the OASIS team is that data collected under this project contributes to LQAS’ viability as a surveillance approach, lowering the threshold to implement AMR surveillance.

During the afternoon session, it was the MAGIcIAN team’s turn to share their findings. Discussing the within-host dynamics of N. gonorrhoea infection and treatment with antibiotics, Ernst Dirk Schäfer presented a mechanistic model of infection evolution that includes interactions between bacteria, host cells and antimicrobial agents. He showed how, in an example of long-term N. gonorrhoea transmission in the presence of background antibiotic exposure, resistant bacteria could emerge through random mutation and selection. 

Afterwards, Davide Vergni, coordinator of Project MAGIcIAN, talked about the evolution and transmission of N. gonorrhea drug resistance using an integrated agent-based multiscale model. He showed that the high flexibility of the model allows the creation of different scenarios of epidemic propagation in the presence of different public health measures of prevention, surveillance, and screening, and can provide an effective decision support system for public health management, also in the view of the introduction of new antibiotics.

With both teams closing out the project, Davide thanked everyone for joining the dissemination day. Afterwards, a roundtable discussion, hosted by Constance Schultsz, was opened with the purpose of reflecting on the learnings of each project both in technical and project implementation aspects.

At the end of the event, the MAGIcIAN and OASIS teams came together to discuss a possible future collaboration despite the projects’ end. Several ideas were explored while it was acknowledged that both projects could work in synergy to further study, advance and improve AMR surveillance. The project teams will reconvene before summer to make the next steps. A surefire signal that both teams truly enjoyed and learned from each other. Surveillance is crucial in every step of the process of curbing AMR. Rethinking the strategies used and defining new and effective approaches requires international collaboration in a One Health setting. Both project teams are grateful for the support of the project funders, the Joint Programming Initiative on Antimicrobial Resistance (JPIAMR), and our project partners to enable this.