Building bridges to operationalise One Health — A longitudinal two years’ AMR study in England using clinical and wastewater-based surveillance approaches

Objectives: The COVID-19 pandemic impacted antimicrobial resistance (AMR) in clinical settings, but evidence is lacking. Considering this, we evaluated community-wide AMR in the shadow of COVID-19, using wastewater-based epidemiology (WBE).  

Methods: 590 wastewater samples were collected from four contrasting communities in England between April 2020 and March 2022 to test for antibiotics used, their metabolites and persistent antibiotic resistance genes (ARGs). Catchment wide COVID-19 cases and antibiotic prescription data were triangulated with WBE data to evaluate impact of COVID-19 pandemic on changes in antibiotics use and resulting AMR at fine spatio-temporal resolution.  

Results: Observed reduction in antibiotic consumption and AMR prevalence during COVID pandemic (especially during lockdowns) is likely due to reduced social interactions rather than due to reduced antibiotic prescribing. This has significant implications for practice and policy that currently focusses on the reduction of antibiotics as the key risk factor in AMR.  

Conclusions: Better, more holistic strategies encompassing One Health philosophy are needed to understand and act upon the AMR challenge. 

 

Papers: 

Building bridges to operationalize One Health—A longitudinal two years’ AMR study in England using clinical and wastewater-based surveillance approaches 

 

Antimicrobials and antimicrobial resistance genes in the shadow of COVID-19 pandemic: A wastewater-based epidemiology perspective 

 

Assessment of the stability of antimicrobials and resistance genes during short-and long-term storage condition: accounting for uncertainties in bioanalytical workflows 

 

Partners: Wessex Water 

 

Funders: Medical Research Council and Newton Fund through a UK-CHINA AMR Partnership Hub Award (MR/S013717/1), EPSRC Impact Acceleration Account (EP/R51164X/1, ENTRUST IAA), Wessex Water Services Ltd. Innovative Pathway Control Project, and GCRF EWS-C19 (EP/V028499/1)