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

Environment

Surveillance

Transmission

Research Project: 2024-04-01 - 2027-03-31
Total sum awarded: €1 572 000

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.

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  • Stephan Harbarth, University Hospital Geneva, Switzerland (Coordinator)
  • Xavier Bertrand, University Hospital of Besançon, France (Partner)
  • Anton Peleg, Monash University, Australia (Partner)
  • Lulla Opatowski, Institut Pasteur, France (Partner)
  • Mical Paul, Rambam Health Care Campus, Israel (Partner)
  • Claude Saegerman, University of Liege, Belgium (Partner)

Carbapenem-resistant bacteria (CPE) and other antibiotic-resistant bugs are becoming a large problem in hospitals; they can cause infections that are difficult to treat. It is important to identify the spread of these drug-resistant bacteria in hospitals to prevent outbreaks and reduce the health impact for patients. At the moment, hospitals only screen high-risk patients to detect whether they carry these drug-resistant bacteria, but this is expensive, uncomfortable for patients, and doesn't always detect all positive patients. It also ignores drug-resistant bacteria in the hospital environment, like in sinks and toilets. In this study, researchers will develop and test a new surveillance method that involves regularly sampling sinks, toilets and hospital wastewater, to detect these drug-resistant bacteria. They will test this method in four different hospitals in Australia, France, Israel and Switzerland. Genetic analyses and mathematical models will also be applied to better understand how these drug-resistant bacteria are spreading between patients and the hospital environment. The goal is to develop a better way of detecting these dangerous bacteria within the hospital, so we can prevent them from spreading to patients and reduce the number of hospital-associated infections.

Call

2023 - Development of innovative strategies, tools, technologies, and methods for diagnostics and surveillance of antimicrobial resistance