MIT Solve

Solution Overview

Solution Name:

ResistApp

One-line solution summary:

Wastewater monitoring for antibiotic resistance to serve as an early warning system for emerging outbreaks of resistant bacteria.

Pitch your solution.

Resistomap is developing ResistApp, a combination of wastewater monitoring using culture-independent methods and a digital platform, to serve as an early warning system for the potential outbreak of antibiotic resistant bacteria in hospitals. Hospitals are antibiotic resistance hotspots due to high prevalence of care through hands, use of invasive devices and antibiotic (over)use. However, there is currently no antibiotic resistance monitoring system that could identify emerging threats and long-term trends in hospitals. ResistApp will be a new technological revolution that serves as an early warning system that allows hospitals to conduct upfront screening and isolation as preventive measures and limit the spread of infections. ResistApp is unique as it combines and standardizes cutting edge microbiological technology with the best visualization techniques to make the spread of antibiotic resistance understandable and preventable. If scaled globally, ResistApp will prevent antibiotic resistance outbreaks in hospitals worldwide.

Film your elevator pitch.

What specific problem are you solving?

Antibiotic resistance is a global health threat that causes more than 700,000 deaths annually. If left unchecked, we face the risk of entering a “post-antibiotic era” in which simple wounds and infections have high mortality rates. It is predicted that inaction will increase the number of deaths caused by antibiotic resistant bacteria to be as high as 10 million per year by 2050. Further, the damage caused by resistant infections would be around 100 trillion USD, making antibiotic resistance not only lethal but a threat to the global economy. The extent of the damage caused by antibiotic resistance will depend on how humanity takes action against the problem.

The monitoring of antibiotic resistance is especially crucial in hospitals as it is oftentimes the centre of outbreaks. One case of antibiotic resistant bacteria outbreak in a hospital is estimated to cost around 1.1 million Euros. One example was the regional outbreak in Tuscany, Italy between November 2018 and May 2019. The outbreak was only detected after 22 weeks; meanwhile, 350 cases and 33 deaths were reported within that period. An early warning system would have allowed the hospital to take preventive measures and so limit the spread of infections.

What is your solution?

Resistomap is developing ResistApp, a digital platform of antibiotic resistance monitoring in hospital wastewater to serve as an early warning system for impending outbreaks of resistant bacteria in hospitals. ResistApp utilizes culture-independent methods and a state-of-the-art technique SmartChip qPCR for the detection and quantification of bacterial genes and antibiotic resistance genes (ARGs) in wastewater. Combined with data science and an online user interface, the digital platform will allow users to view detailed information on the presence and abundance of antibiotic resistance genes in hospital wastewater, including resistance against antibiotics that are commonly used in hospitals. Through the interactive dashboard, users can see the number of detected ARGs in each sample over time, the relative abundance of detected genes, and a heatmap that shows the resistance profiles. This allows users to have in-depth information on the levels of antibiotic resistance from their samples, and to compare the levels of resistance between samples and over time. The platform also provides a global map of antibiotic resistance in wastewater.

Who does your solution serve, and in what ways will the solution impact their lives?

Current coronavirus pandemic has shown us the devastating impact of an outbreak. Not only human health, but outbreaks also have significant negative effects on the global economy. This highlights the importance of taking preventive steps to avoid similar outbreaks from happening in the future. The standardised and comparable monitoring data produced by ResistApp will be essential for the scientific community, healthcare sector and wastewater treatment industry to understand the spread of antibiotic resistance and to learn how to mitigate it.

The main beneficiaries of ResistApp are as follows:

Infectious disease control unit. Detailed and comprehensive information on antibiotic resistance levels will contribute to improved management and policies for preventing infections in hospitals.
Immunocompromised- and cancer patients. Since antibiotics are crucial for these patient groups, preventing outbreaks of resistant bacteria will ensure the effectiveness of antibiotics for these patients.
Local communities. As hospitals are the main source of resistant bacteria, preventing resistant bacteria outbreaks in hospitals will reduce its spread to local communities, thus protecting their health and productivity.

In addition, ResistApp has the potential to generate social, economic and environmental impact to the larger population.

Social impact. Antibiotic resistant infections lead to higher medical costs and increased mortality. By preventing antibiotic resistance outbreaks, we can ensure the effectiveness of antibiotics and so better protect public health. Preventing outbreaks also ensure that hospital activities remain uninterrupted and that society has access to medical care and treatments.

In addition, preventing antibiotic resistance outbreaks has positive outcomes for those living in poverty. Antibiotic resistance strikes hardest at the poor; insufficient sanitation and hygiene lead to higher transmission of infections, which leads to higher antibiotic consumption. Due to antibiotic resistance, effective treatment of many bacterial infections is unavailable for many people in low- and middle-income countries. Hence, limiting the spread of antibiotic resistance will have positive implications towards the health of the poor.

Economic impact. Monitoring antibiotic resistance will help protect the local and global economy from the negative economic implications of a pandemic. Antibiotic resistant outbreaks are extremely costly. It was estimated that treating one patient with an antibiotic resistant infection requires an additional 8 000 to 30 000 Euros. During an outbreak, hospitals need to increase ICU and hospital stays, provide extra medical care and support, and conduct additional diagnostic tests. Increased mortality, prolonged sickness and reduced work efficiency due to antibiotic resistant infections in a community will also reduce economic outputs and negatively influence the local economy.

Environmental impact. Preventing antibiotic resistance outbreaks in hospitals will minimise the spread of resistant bacteria in the environment, as antibiotic resistant bacteria and their genes can enter water environments through hospital wastewater. Our wastewater monitoring system thus contributes to clean water and sanitation.

Which dimension of the Challenge does your solution most closely address?

Strengthen disease surveillance, early warning predictive systems, and other data systems to detect, slow, or halt future disease outbreaks.

Explain how the problem you are addressing, the solution you have designed, and the population you are serving align with the Challenge.

Current COVID-19 pandemic has negative implications towards the global antibiotic resistance situation and could lead to the rapid spread of antibiotic resistance in hospitals. Wastewater monitoring could monitor the prevalence of antibiotic resistance effectively and efficiently. The data produced will be essential for hospitals to understand the spread of antibiotic resistance and to learn how to mitigate it. Wastewater monitoring also takes into account a larger representative of the population, thus serving as an early warning system for future outbreaks of antibiotic resistant bacteria, especially in hospitals.

In what city, town, or region is your solution team headquartered?

Helsinki, Finland

What is your solution’s stage of development?

Pilot: An organization deploying a tested product, service, or business model in at least one community.

Explain why you selected this stage of development for your solution.

We have obtained the Proof-of-Concept (PoC) for ResistApp through a project with Helsinki University Hospital (HUS) and Viikinmäki wastewater treatment plant (WWTP) in Finland. In this project, we routinely monitored the presence and levels of pathogens and antibiotic resistance genes in wastewater from two HUS hospitals and the WWTP from May to September 2020. In addition, we are now conducting a pilot project to implement the wastewater monitoring system in three hospitals in Indonesia: RSUPN Dr. Cipto Mangunkusumo (Jakarta), RSUP Persahabatan (Jakarta), and RSUD Dr. Saiful Anwar (Malang). These three hospitals are surveillance sites for Indonesia’s participation in the Global Antimicrobial Resistance Surveillance System (GLASS), a platform launched by the World Health Organization (WHO) to support national antimicrobial resistance surveillance systems. Following the pilot project, we will be able to compare the levels of pathogens and antibiotic resistance in hospital wastewater and the national data collected through GLASS.

Who is the Team Lead for your solution?

Windi Muziasari, PhD

More About Your Solution

If your solution has a website or an app, provide the links here:

https://www.resistomap.com/

Which of the following categories best describes your solution?

A new application of an existing technology

What makes your solution innovative?

There are two important limitations to how antibiotic resistance is currently monitored in hospitals. First, current monitoring focuses mainly on a limited number of pathogenic bacteria. Second, it is often based on passive surveillance of bacteria isolated from patients. This leads to delayed detection of outbreaks, non-comparable data, and the inability to capture other pathogenic bacteria and antibiotic resistance profiles which are often carried by commensal bacteria.

Wastewater-based monitoring with ResistApp will be a potentially valuable addition to current options for antibiotic resistance monitoring in hospitals. Though not a substitute for existing monitoring methods, wastewater monitoring can provide data that is otherwise hard to obtain and become the easiest means for obtaining comprehensive information on the prevalence of resistance in hospitals. As waste from all patients are released into wastewater, wastewater monitoring can cover a wider range of antibiotic resistance profiles compared to the partial data from a few selected pathogenic bacteria. In addition, analyzing wastewater samples does not require informed consent, thus limiting ethical concerns. The practical and logistical barriers for sampling wastewater is also limited. ResistApp can therefore be used to better understand the development and spread of antibiotic resistant bacteria in hospitals, and serve as an early warning system for future outbreaks.

Please select the technologies currently used in your solution:

Biotechnology / Bioengineering
Software and Mobile Applications

Select the key characteristics of your target population.

Peri-Urban
Urban
Low-Income
Middle-Income

Which of the UN Sustainable Development Goals does your solution address?

3. Good Health and Well-being
6. Clean Water and Sanitation
9. Industry, Innovation and Infrastructure
11. Sustainable Cities and Communities
12. Responsible Consumption and Production

In which countries do you currently operate?

Finland
Indonesia

In which countries will you be operating within the next year?

Finland
Indonesia

How many people does your solution currently serve? How many will it serve in one year? In five years?

Since its establishment in June 2018 in Helsinki, Finland, Resistomap has served 85 projects from over 24 different countries. Our paying customers are mainly from universities and research institutes (see Image below). In addition to our monitoring service, we have also organized multiple webinars that aim to improve awareness on antibiotic resistance in the environment and the urgent need to improve monitoring, especially in low- and middle-income countries. The webinars were attended by over 1000 participants from 50 different countries.

For ResistApp, we currently have projects in Finland and Indonesia. After obtaining the Proof-of-Value, our goal in the coming year is to have ResistApp implemented as an early warning system in hospitals in both Finland and Indonesia. This will enable ResistApp to have a positive impact on the lives of more than 250 million people.

Our target for the next five years is to have ResistApp installed in hospitals in Europe and Southeast Asia. We also aim to have ResistApp installed in municipal wastewater treatment plants in Europe to improve the monitoring of (hospital) wastewater on the municipal level.

How are you measuring your progress toward your impact goals?

Proportion of hospital wastewater outflows with reduced levels of antibiotic resistance genes and resistant pathogenic bacteria
Incidence rate of outbreaks of antibiotic resistant bacteria in hospitals
Number of countries with early warning systems for outbreaks of antibiotic resistant bacteria

About Your Team

What type of organization is your solution team?

For-profit, including B-Corp or similar models

How many people work on your solution team?

Fulltime staff: 2

Part-time staff: 5

Contractor: 2

Student Intern: 1

Advisor: 3

How long have you been working on your solution?

2 years

How are you and your team well-positioned to deliver this solution?

FULL-TIME:

1. WINDI MUZIASARI (Indonesian, F)

Owner, Co-Founder & CEO

PhD, Microbiology & Biotechnology (University of Helsinki)

+10 years Monitoring antibiotic resistance in the environment

World’s Top 5 Experts on antibiotic resistance monitoring using SmartChip qPCR technology

2. JESSE MAJLANDER (Finnish, M)

Operations Manager

MSc, Microbiology (University of Helsinki)

Chairman of One Health Finland Ry

+5 years Molecular microbiology laboratory

PART-TIME:

1. WILLIAM NURMI (Finnish, M)

Owner, Co-Founder & CTO

MSc, Computer Science (University of Turku)

+8 years Software Development

2. BERNADETTA GINTING-SCSZESNY (Indonesian, F)

Global Business Project Manager

MSc, Social Psychology

PhD candidate at Dept. of Management (Aalto University)

3. LOTTA PEUSSA (Finnish, F)

Administrative Manager

MSc, Research Methods in Psychology (University of Bristol)

4. ALMA SEPPÄLÄ (Finnish, F)

Laboratory Technician

MSc, Microbiology (University of Helsinki)

5. MATTIAS SZCZESNY (Swedish, M)

Marketing

BSc, Event Management (Haaga-Helia University of Applied Sciences)

CONTRACTOR:

1. IRWIN YUSTIANSYAH (Indonesian, M)

Brand & Design

+10 years Graphic Design

2. KUL SHANKER SHRESTHA (Nepalese, M)

Data Scientist

PhD, Biomedicine (University of Helsinki)

STUDENT INTERN:

1. AGATHA PRIANDINI (Indonesian, F)

BSc, Social Science (Waseda University)

ADVISORY BOARD:

1. PROF. JAMES TIEDJE (American, M)

Michigan State University

University Distinguished Professor

40+ years of antibiotic resistance research

2. VELI-JUKKA ANTTILA (Finnish, M)

Helsinki Central Hospital (HUS), Finland

Head of Infectious Diseases Control Unit

3. CHRIS MOORE (British, M)

Managing Director of Nordic Group

20+ years of business in health sector

What is your approach to building a diverse, equitable, and inclusive leadership team?

Resistomap accepts and values differences in the team. Our team consists of five women and five men originating from Indonesia, Nepal, Finland and Sweden. All team members, regardless of background, specialization and experience, have the opportunity to join one of the parallel projects that cross over the various departments in the company. Involvement is highly encouraged provided that it does not clash with individual tasks and assignments. We also organize a monthly meeting with all team members to build transparency between departments and projects, and to ensure that all members are engaged and included in the direction of the company.

Your Business Model & Partnerships

Partnership & Prize Funding Opportunities

Why are you applying to Solve?

Resistomap's mission aligns with the goals of the Global Challenge -- we seek to protect people and communities from future antibiotic resistance outbreaks by introducing ResistApp as an early warning system in hospitals. We believe that becoming a Solver will help us further develop ResistApp and increase its social impact, thus ensuring that our solution can bring positive change to the lives of many. We seek to be part of MIT’s innovation ecosystem and to receive guidance and mentorship from experts and experienced entrepreneurs. Further, as part of the community of Solvers, we wish to support and be inspired by other tech-based social entrepreneurs.

In which of the following areas do you most need partners or support?

Financial (e.g. improving accounting practices, pitching to investors)
Legal or Regulatory Matters
Public Relations (e.g. branding/marketing strategy, social and global media)
Monitoring & Evaluation (e.g. collecting/using data, measuring impact)
Technology (e.g. software or hardware, web development/design, data analysis, etc.)

Please explain in more detail here.

To further develop ResistApp, we seek advice, mentorships, or partners for the following:

Identify suitable grants, funding bodies and/or investors
Address potential legal barriers that could hinder the development of an open database for sharing the results of antibiotic resistance spread in hospitals
Create an effective marketing and outreach strategy to reach potential users in Europe and Southeast Asia
Develop impact measurement tools for monitoring and understanding the change brought about by ResistApp
Develop the front-end of ResistApp through user experience design to ensure that our solution fulfils the hospitals’ needs

Do you qualify for and would you like to be considered for the Robert Wood Johnson Foundation Prize? If you select Yes, explain how you are qualified for the prize in the additional question that appears.

No, I do not wish to be considered for this prize, even if the prize funder is specifically interested in my solution

Do you qualify for and would you like to be considered for The Andan Prize for Innovation in Refugee Inclusion? If you select Yes, explain how you are qualified for the prize in the additional question that appears.

No, I do not wish to be considered for this prize, even if the prize funder is specifically interested in my solution

Do you qualify for and would you like to be considered for the Innovation for Women Prize? If you select Yes, explain how you are qualified for the prize in the additional question that appears.

No, I do not wish to be considered for this prize, even if the prize funder is specifically interested in my solution

Do you qualify for and would you like to be considered for The AI for Humanity Prize? If you select Yes, explain how you are qualified for the prize in the additional question that appears.

No, I do not wish to be considered for this prize, even if the prize funder is specifically interested in my solution

Do you qualify for and would you like to be considered for The Global Fund Prize? If you select Yes, explain how you are qualified for the prize in the additional question that appears.

No