STRESST

Antimicrobial Stewardship in Hospitals, Resistance Selection and Transfer in a One Health Context

STRESST

The workplan

Antimicrobial Stewardship 

Antimicrobial Stewardship interventions will be introduced across Queen Elizabeth Central Hospital in Blantyre, Malawi.

Hospital wastewater acquisition

Bespoke hospital wastewater sewage samplers will be used to acquire samples before and during the hospital wide antimicrobial stewardship interventions.

Microbiological analysis of hospital wastewater 

Susceptible and resistant bacteria will be grown, identified and enumerated. The mechanisms of resistance will be determined.

Chemical analysis of hospital wastewater

The hospital wastewater will be analysed by chemists to determine the levels of antibiotics that are leaving the hospital ground in the hospital wastewater.

Analysis of horizontal gene transfer of antimicrobial resistance genes

Rates of transfer by conjugation will be determined in the presence of different concentrations of antimicrobials found in the hospital wastewater by using state of the art fermenters which allow us to model the chicken caecum.

Analysis of intracellular transposition of antimicrobial resistance genes

The ability of mobile genetic elements to jump between plasmids or between plasmids and the chromosome inside a bacterial cell will be determined using newly developed molecular biology assays.

Supporting studies

Lester R, Haigh K, Wood A, MacPherson EE, Maheswaran H, Bogue P, Hanger S, Kalizang'oma A, Srirathan V, Kulapani D, Mallewa J, Nyirenda M, Jewell CP, Heyderman R, Gordon M, Lalloo DG, Tolhurst R, Feasey NA. Sustained Reduction in Third-generation Cephalosporin Usage in Adult Inpatients Following Introduction of an Antimicrobial Stewardship Program in a Large, Urban Hospital in Malawi. Clin Infect Dis. 2020 Dec 3;71(9):e478-e486. doi: 10.1093/cid/ciaa162. PMID: 32060523; PMCID: PMC7713689.

Tansirichaiya S, Moyo SJ, Al-Haroni M, Roberts AP. Capture of a novel, antibiotic resistance encoding, mobile genetic element from Escherichia coli using a new entrapment vector. J Appl Microbiol. 2021 Mar;130(3):832-842. doi: 10.1111/jam.14837. Epub 2020 Sep 17. PMID: 32881179.

Tansirichaiya S, Goodman RN, Guo X, Bulgasim I, Samuelsen Ø, Al-Haroni M, Roberts AP. Intracellular Transposition and Capture of Mobile Genetic Elements following Intercellular Conjugation of Multidrug Resistance Conjugative Plasmids from Clinical Enterobacteriaceae Isolates. Microbiol Spectr. 2022 Jan 19;10(1):e0214021. doi: 10.1128/spectrum.02140-21. Epub ahead of print. PMID: 35044219; PMCID: PMC8768599.

Principal Investigators

Dr Adam Roberts 
LSTM

Dr Andrew Singer
UK Centre for Ecology & Hydrology

Prof Nina Langeland
University of Bergen

Dr Michael Brouwer
Wageningen Bioveterinary Research

Professor Nicholas Feasey
LSTM/MLW

NEAR-AMR: Network of European and African Researchers on Antimicrobial Resistance

All members of the STRESST consortium are part of the JPIAMR funded network of European and African
Researchers on AMR (NEAR-AMR)