Exploring Health and Environment Nexus: Embarking on our Comprehensive Research Journey

In response to the growing challenge of antimicrobial resistance (AMR), our group at Ashoka University has emerged as a force, pioneering an initiative that transcends the boundaries of conventional healthcare. Guided by a multi-faceted vision to address AMR, we have collaborated with various partner institutions. Our mission is to establish a clinical foundation that underscores the importance of wastewater surveillance and aids to unravel the interplay between healthcare and the environment.

A vision beyond boundaries

An important aspect of our approach is to study clinical isolates – samples of bacteria or pathogens obtained from patients in healthcare facilities. Analyzing these isolates will allow us to understand patterns and prevalence of antimicrobial-resistant strains within clinical facilities. This will also help us discern the potential origins of antibiotic-resistant genes that may eventually find their way into wastewater systems.

Engaging with Partners: Building bridges of collaboration

Our success lies in our ability to forge meaningful collaborations with the hospitals, pathology labs and epidemiologists for their expertise, procurement of bacterial samples and data on anti-biotic resistance (antibiogram) for robust AMR surveillance. Their clinical insights are pivotal in shaping diagnosis and treatment. Through personalized interaction with the concerned authorities, we seek to bridge the gap between their expertise and the urgent need for comprehensive AMR surveillance which requires interventions and policies to safeguard public health. By showcasing the potential of their work to effect real change, we inspire a sense of purpose and shared responsibility. Central to our strategy is also a focus on mutual benefit. We highlight the potential for collaboration to enhance their research efforts as well. By contributing to AMR surveillance, they become part of a global network that enriches their understanding of bacterial behavior and resistance mechanisms. This reciprocity strengthens our bond and transforms the collaboration into a knowledge exchange partnership. Through these strategies, we have successfully partnered with three major multispecialty hospitals including Sahyadri Hospitals in Pune, Max Healthcare in Delhi, and Noble Hospitals in Pune.

Charting the course with clinical data collection

Our collaborations with the hospitals have enabled the collection of clinical data which was the primary step to solving a multidimensional puzzle. At the core of our clinical data are the patients, each represented by a constellation of attributes including age, sex, infection source, pathogen and the antibiograms. Patient age and gender can reflect susceptibility patterns, while sample specimens reveal the source of infections. Identification of the organism responsible for AMR, aids in targeted interventions. The true essence of clinical data collection for AMR surveillance lies within the antibiogram—a roadmap detailing the susceptibility of organisms to antibiotics, which we are obtaining through our collaborators. This dynamic chart shapes treatment strategies and highlights the urgent need for responsible antibiotic usage. The year of collection of the data integrated with the antibiograms shed light on the emerging trends in antibiotic resistance.

Harmonizing healthcare data

By delving into this extensive information repository, we acquired a comprehensive understanding of AMR trends. Our methodology entailed meticulous scrutiny of patient data, sample attributes, and antibiogram profiles. Notably, ICMR and DBT have introduced a catalog of priority pathogens. Exploring their occurrence within our clinical data, we generated an inventory encompassing potential pathogen-resistance profile-specimen combinations. With this compendium in hand, we promptly receive notifications from hospitals upon identification of target pathogens. Subsequently, a validation process ensues to assess the suitability of the pathogen for sequencing analysis. We have successfully sequenced 60 isolates to generate high-quality complete genomes, furthering our exploration of resistance mechanisms.

From Clinical Understanding to Environmental Influence: Our Path Ahead

Clinical isolates provide a foundation, revealing prevalence, resistance patterns, and genetic makeup of antimicrobial-resistant strains. By tracing genetic connections between clinical and wastewater samples, researchers map the routes of resistant bacteria transmission. These insights guide the selection of isolates for further analysis, enabling a deeper understanding of resistance dissemination in the environment. Through examination of clinical isolates, our project envisions an interaction between the clinical foundation and the broader environmental context. This effectively underscores interconnectedness of these elements, portraying a dynamic interplay within our canvas of work. Through our visionary pursuit, we seek to not only address the present challenges of AMR but also chart a course towards a future where the intricate tapestry of healthcare and environment is woven seamlessly together.