What is the problem?

Antibacterial drug resistance (ABR) is a significant source of excess mortality in Overseas Development Assistance (ODA) countries. AMR (predominantly ABR) is estimated to have caused 38,000 deaths and an economic loss of 1.2 billion US$ in Thailand in 2010. ABR is common in human, environmental and animal bacterial isolates, where tested.

The Thai National Strategic Plan on AMR (2017-2022) has been developed to reduce ABR. Strategies include a “One Health” AMR surveillance system; regulation of antimicrobial (AM) distribution; better infection prevention and control and AM stewardship in humans, agriculture and companion animals; improved public knowledge on AMR and awareness of appropriate AM use; governance mechanisms to develop and sustain AMR-related actions.

Because of good record keeping and surveillance, Thailand has been used as an exemplar for characteristics of ABR in ODA countries. ABR is common in human, environmental and animal bacterial isolates. However, ABR has mostly been studied separately in discrete sectors (e.g. hospital patients or poultry). The key drivers of ABR relevant to human health cannot be pinpointed in this way because the selection and transmission of ABR results from interactions between humans, animals, and the environment. A "One Health" approach to the problem is required.

What is the research being carried out?

We will study the Enterobacterales family bacteria Klebsiella pneumoniae and Escherichia coli, which reside in the human and animal gut, are common in environments contaminated with faeces, and are considered a significant threat to human health in Thailand. They are commonly carbapenem- and/or 3rd generation cephalosporin-resistant (3GCR), which are drugs commonly used for serious infections.

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. The term "driver" may refer to: 1) a material condition or substance, such as a chemical (e.g. an Antibiotic), which, at a particular concentration, selects for the increased prevalence of ABR bacteria; 2) an action, such as exposing bacteria to that chemical by taking an antibiotic; or 3) a socioeconomic condition or circumstance which accounts for that action (e.g. the economic necessity to keep working in the face of illness). A full understanding of ABR drivers at every level is important for the design of effective and appropriate interventions to limit ABR. Hence, this interdisciplinary consortium will investigate them all.

Outcome and next steps

The project has completed all sample and data collection. 9000 samples have been processed (from humans, farms, wider environments and food at various markets) to test for ABR bacteria. 4000 resistant bacteria have been analysed to determine resistance mechanism and co-resistance. 3000 resistant bacteria have been sequenced. Survey and medicines usage data have been collected for hospitalised patients and people in the community, and from almost 60 farms (poultry and aquaculture). Chemical/heavy metal residues analysis has been performed for >3000 samples from across the study site. Qualitative and ethnographic work has been completed with 20 case study households and all the study farms. Data analysis/modelling is ongoing, but we have already modelled the potential impact of potential strategies within the next Thai 5-year National Strategic Plan (Booton et al, 2021 One Health 12:100220).