Global Surveillance of Antimicrobial Resistance

The Global Surveillance of Antimicrobial Resistance project works from the hypothesis that human sewage can be used to detect, and combined with epidemiological / ecological modeling, explain emergence and trends of antimicrobial resistance (AMR).

From a surveillance point of view, sewage is an attractive matrix because it combines material from a large and mostly healthy population, which would otherwise not be feasible to monitor. Consequently, sewage has been used for interesting studies related to illegal drug usage. Most microbiological studies have been in relation to the risk of insufficiently treated sewage or to heavy rainfall overflow, but some evaluations on the surveillance of pathogens have also been performed. Utilizing meta-genomic sequencing (high-throughput sequencing of all genetic material simultaneously) and quantifying all AMR genes will provide a much broader resolution than offered by current methodologies.

With this project we aim to change the foundation of AMR surveillance by combining global sampling sites with new sequencing technologies, bioinformatics and epidemiological analyses. Global point prevalence and local (Copenhagen) longitudinal samples will be collected and analyzed by meta-genomic deep sequencing. The sequencing data will be further analyzed with advanced bioinformatics methods quantifying AMR genes as well as related mobile elements and species distributions. The resulting abundance profiles will be further analyzed using newer epidemiological and ecological models to obtain relevant quantification and indexes from each sample. These data will be associated to explanatory variables and models for AMR forecasting, surveillance and global emergence and transmission developed. A large part of the data generated will be released in real-time, as will the scientific analysis. This will be done both to avoid the time delay associated with publication and to engage the global research community and general public.

Recently a successful pilot project sampling of sewage from 78 cities in 63 countries was completed, representing all continents, i.e. Asia, Africa, North America, South America, Europe, and Australia except for Antarctica.

This project will be conducted as a collaboration between three well-established and internationally well-known research groups, namely: Research group for Genomic Epidemiology, the National Food Institute, DTU, Center for Biological Sequence Analysis (CBS), DTU and the Epidemiology Research Group, University of Edinburgh.

This project is funded by the Novo Nordisk Fonden (NNF).