One Health drivers of antibacterial resistance in Thailand

This project aims to develop an understanding of the One Health drivers of AMR in rural Thailand (OH-DART).

What is the problem?

Antimicrobial drug resistance (AMR) is a significant cause of death in Thailand, and estimated to have caused 38,000 deaths and an economic loss of 1.2 billion US$ in Thailand in 2010. This is mostly due to antibacterial resistance (ABR) which is common in bacteria isolated from humans, animals and the environment. Thailand is considered to be very representative for the characteristics of ABR in Overseas Development Assistance (ODA) countries, and has a National Strategic Plan on AMR (2017-2021), developed to reduce death, illness and economic impacts from AMR. The goals for this action plan are reducing AMR morbidity by 50%, reducing AM use in humans and animals and increasing public awareness on appropriate use of AM’s and understanding of AMR, with a multi-sector One-Health approach.

The development of ABR in bacteria, and the transmission of this resistance, is driven by multiple factors that require a One-Health approach which considers interactions between humans, animals and the environment. ABR has mostly been studied by focusing on specific sectors, such as hospital patients or in poultry, rather than in a more holistic way. In our work we aim to draw together information from different sectors, using an interdisciplinary approach and focusing on two bacterial species to unravel some of the complex factors that influence the selection and transmission of antibacterial resistance

What is the research being carried out?

The bacteria we are studying are members of the the Enterobacteriaceae family, Klebsiella pneumoniae and Escherichia coli. Both live in human and animal guts are commonly found in environments contaminated with faeces. They can cause opportunistic infections leading to disease, and are considered a significant threat to human health in Thailand. Both can be resistant to carbapenem and/or 3rd generation cephalosporins, which are drugs commonly used for serious infections. Resistance to these drugs is commonly found in Thailand.

In order to study these bacteria, 9000 samples are being collected from different sites around an area in central Thailand and tested for the presence of resistant Klebsiella spp. and E.coli. These sites include farms, markets, waterways and industrial sites, as well as human faecal samples from residents of the study area. At the same time we are collecting data on water usage, antibiotic usage, farm management, levels of various chemicals in different environments, household management and attitudes to antibiotic resistance, using a combination of methods ranging from questionnaires to participant observation andusing a wide range of quantitative and qualitative research methods to investigate all of these potential drivers of antibacterial resistance.

Examples of drivers of resistance could be chemicals which, at a particular concentration selects for increased prevalence of ABR bacteria, or actions such as taking an antibiotic. or socioeconomic circumstances which accounts for that action, such as the economic necessity to keep working in the face of illness. This understanding of ABR drivers at different levels is important for the design of effective and appropriate interventions to limit ABR, and our consortium's vision is to build a holistic picture of the drivers of ABR in Thailand and to use this information to benefit the Thai people, and as an exemplar for other ODA countries.

Outcome and next steps

The project is nearing the end of the sample and data collection phase. As of October 2020 over 6000 samples have been taken from different environments around the study area for microbiological testing, and a large number of samples have also been subjected to testing for the presence of various chemicals. As well as this, collection of a large quantity of interview and observational data is ongoing, as is collection of information about antibiotic use in the community.

We anticipate finishing all data collection by December 2020, and hope to be able to start sharing results of the study very soon after this.

Prof Matthew Avison discusses the new £2.9m GCRF award aimed at tackling antibacterial resistance in Thailand.

Researchers involved

  • Prof Matthew Avison (School of Cellular and Molecular Medicine)
  • Dr Kristen Reyher (Bristol Veterinary School)
  • Dr Katy Turner (Bristol Veterinary School)
  • Prof Helen Lambert (Bristol Medical School)
  • Prof Ed Feil (University of Bath)
  • Prof Henry Buller (University of Exeter)
  • Dr Emma Pitchforth (University of Exeter)
  • Dr Andrew Singer (NERC Centre for Ecology and Hydrology)
  • Prof Skorn Mongkolsuk (Chulabhorn Research Institute, Bangkok)
  • Dr Jutamaad Satayavivad (Chulabhorn Research Institute, Bangkok)
  • Prof Visanu Thamlikitikul (Mahidol University, Bangkok)
  • Prof Parntep Ratanakorn (Mahidol University, Bangkok)
  • Dr Walasinee Sakcamduang (Mahidol University, Bangkok)
  • Prof Luechai Sringernyuang (Mahidol University, Bangkok)
  • Dr Aronrag Meeyai (LSHTM)
  • Dr Punyawee Dulyayangkul (School of Cellular Molecular Medicine)
  • Dr Ross Booton (Bristol Veterinary School)
  • Dr Nour Alhusein (Bristol Medical School) 
  • Dr Marjorie Gibbon (University of Bath)
  • Dr Natacha Couto (University of Bath)
  • Dr Nisanart Charoenboom (Chulabhorn Research Institute, Bangkok)
  • Dr Kwanrawee Sirikanchana( Chulabhorn Research Institute, Bangkok)
  • Dr Tawit Suriyo (Chulabhorn Research Institute, Bangkok)
  • Dr Boonrat Chantong (Mahidol University, Bangkok)
  • Dr Sarin Suwanpakdee (Mahidol University, Bangkok)
  • Dr Anuwat Wiratsudakul (Mahidol University, Bangkok)
  • Dr Varapon Montrivade (Mahidol University, Bangkok)

Funding

  • Tackling AMR - A Cross Council Initiative MRC/DoH-led ‘AMR in a Global Context’ development and full awards

Contact

Prof Matthew Avison
email: matthewb.avison@bristol.ac.uk
tel: +44 (0)117 33 12063

Project Manager: Dr Ginny Gould 
email: v.c.gould@bristol.ac.uk

 

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