Waste water surveillance & AMR

 We propose using waste water as a surrogate marker for establishing the AMR in the community. This data can be used to develop a software which will calculate a probability risk score from the waste water surveillance of STPs/drains of particular communities to identify the AMR pattern. 

Dr Chaitra K

 The review on Antimicrobial Resistance, commissioned by the UK Government aurgued that AMR could kill 10 millionpeopleper year by 2050. As per the article published in the Lancet in Feb 2022, there have been an estimated 4.95 million deaths associated with bacterial AMR in 2019, including 1.27 million deaths attributable to bacterial AMR. The six leading pathogens for deaths associated with resistance are E coli, Staphylococcus aureus, Klebsiella pneumoniae, Streptococcus pneumoniae, Acinitobacter baumannii and Pseudomonas aeruginosa. 

In the Indian scenario, apart from the documented AMR through antibiograms in good "A" category hospitals in the Metro cities, there is no other way of tracking and calcualting the AMR. So, hospital data on AMR is missed out in more than 60% of the hospitals which are smaller and are located in tire 2 and 3 cities and towns of India. Currently, there is no way of tracking community AMR.  Hence, we propose to use wastewater as a surrogate marker to calculate the AMR for both the hospitals and the community. This software developed will give a direction for hospitals to formulate restricted antibiotic usage policy. The community AMR data will empower public health authorities and citizens with their own real-time data.

a)A pilot will be performed at closed hospital environment at Dhee Hospitals, Bangalore. The waste water from the hospital's STP will be analysed for the key pathogens listed above and the AST will be done using Vitek. Carbapenems and colistin resistance will be tested by LC MS/MS. The AMR and antibiotic data thus obtained will be compared and correlated to the hospital's AMR and pharma sales data.A software will calculate the  AMR pattern for the hospital. 

b)The same model will be replicated in the nearby community at 4 different apartment complexes where we will test for same pathogens,
compare this data with interviews of community members, pharma shops and local doctors. The data will be used to analyze predict the community AMR data specific to the waste water analyzed from the apartment complexes. Temporal and spatial trends of viral or bacterial data will be included.

c)Once the data is generated at these pilot levels, we will move to rural areas and do the same exercise there.

All these data points will be fed into the software which will work on ML algorithms and give AMR scores.
The target audience will be-

 Hospitals

 Community - Gated apartment complexes

 Rural PHCs

 Open community drains

Public Good:

Our solution empowers the public with the knowledge and easy to interpret scores on the most prevalent infections and their respective AMR scores which is specific to their area of livelihood. This will enable the public to take action based on their own data.

The software will be available to be used as free-to-use dashboard for everyone in that particular community.

For hospitals and gated apartment complexes who want end-to-end service from collection of waste water to analysis and dashboard with AMR pattern at periodic intervals, it will be available as at-cost delivery of services at a nominal cost on subscription based model.

Our solution will have a tangible impact in the following ways-

1. The hospitals which use our services will get real time updated data on AMR pattern in the hospital so that they formulate a good restricted antibiotic usage policy. This will ensure that the reserve antibiotics are used only for those patients who are resistant to all other antibiotics. The drug resistance index of each hospital can be monitored. An improvement in the Drug Resistance Index over a period of 1 year will show the positive impact through our solution.

2. The community AMR data will be made available to the local pharmacies and practicing General Physicians in the locality so that they are aware of the situation and will prescribe accordingly.

3. The dashboard can also detect and alert any clustering and possibility of outbreak of the pathogens analyzed in each community where the solution is deployed periodically. This will enable the citizens to take appropriate corrective cations such as isolation and preventive action whenever necessary.

4. The impact of solution implementation at the rural, taluk and district level will be in the availability of baseline

prevalence and AMR data which will enable health authorities to formulate antibiotic usage policies in these areas.

The impact will be scaled to include all the communities, layouts, taluks, districts, villages and all the hospitals across India initially. Also all the gated communities and apartmet complexes across cities in India.

The same will be scaled globally in other LSMEC where AMR is a big challenge.

The sucess of this solution's impact can be measured as follows-

1. Availability of baseline AMR data in rural, taluk and districts of India.

2. Reduction in AMR scores in communities and gated apartment complexes in major cities of India who are using our solution end-to-end continuously for 1 year.

3. Reduction in the Drug Resistance Index in the hospiatls using our solutions for 1 year or more.

Barriers to the solution:

1. Financial- We have done the market survey on the knowledge level and understanding of AMR by the general public and the hospitals. Every one wants to participate in the study, provided it is done Free of Cost.

2. Permissions: To take this solution to the level of District, Taluk and villages, we will need permission from the State and Central Government authorities which will be difficult to get.

Overcoming the barriers:

1. As a part of pilot and research, the solution of end-to end services of Waste water surveillance and software services will be provided free of cost. The grant money will be utilised for processing waste water and running cultures and sensitivity and genomic study for antibiotic resistance of the chosen 6 organisms. This modelcan be sustained for 2 years after which the product will have enough data for showcasing as a bussiness model and charge a subscription fees.

2. The solution will be discussed with Health and Family welfare department and appropriate permissions will be sought to go out into district, taluk and villages of India.

Why this challenge?

 Being a lead of laboratory medicine in a hospital based lab, I have been seeing the AMR increasing at an alarming rate and the number of multidrug resistant organisms are on the rise. I have been witnessing that patients are losing lives to MDR sepsis than to cancer directly. Hence, I have chosen this as a challenge to offer a solution.

Barriers that Trinity Challenge can help overcome:

1.The solution is as of now in the proof of concept stage. 

2.We need equipments and collaboration with IT team to implement the solution proposed. All these cost us financially which Trinity will help with the prize money.

1. Primary Health Care at rural level in Karnataka, India

2. Hospitals in all the towns and cities

3. Tertiary care hospitals

4. UNICEF

5. WHO

These organisations will help us connect with others working on global level on the same issue and help in implementing across other LMSEC.