Antimicrobial Resistance has become a ‘silent pandemic’: expert

Sewage sample surveillance being carried out in some of the major cities in India has been indicating a high prevalence of Antimicrobial Resistance in environment; effective and constant surveillance can help find out which antibiotics will not work and where to reduce unnecessary use, says Tata Institute for Genetics and Society director Rakesh Mishra

TIGS director Rakesh Mishra

Antimicrobial Resistance (AMR) to existing antibiotics has already reached a silent ‘pandemic’ stage. Sewage sample surveillance being carried out in some of the major cities has been giving sufficient indication of the same, according to director of Tata Institute for Genetics and Society (TIGS) Rakesh Mishra.

“We are seeing a trend in the sewage samples. AMR can be identified very accurately even when there is under-reporting at the clinical level as everyone uses the toilet and bugs will reach the sewage system in some form or the other,” pointed out Dr. Mishra, who is also the former director of CSIR-Centre for Cellular and Molecular Biology (CCMB).

Highlights

• A huge effort is being put into wastewater surveillance in Bengaluru, Hyderabad, Pune and Delhi for the past one-and-a-half years.
• Its major objective is to establish robust protocols, indigenise required reagents/consumables, build the capacity for human resource/training and spread awareness
• Dr. Mishra says a common website is on the anvil for better communication. It can also serve as a public outreach to educate the people and avoid misuse of antibiotics

The CCMB and its sister organisation CSIR-IICT have been carrying out sewage studies quite successfully from the COVID-19 pandemic time by collecting and analysing samples from open drains and, when permitted, from the Sewerage Treatment Plants (STPs) of the Twin Cities.

“We can easily make out that there is a large presence of AMR in our environment. Through gene profiling, we can check what antibiotics are not going to work and where we can reduce unnecessary usage. We can, in fact, have different profiles for different areas/cities based on STP sampling. Hence, there is a definite need to scale up the environment surveillance,” explained the top scientist, who continues to do research and guide his research students at CCMB here.

Dr. Mishra said that through ‘meta-genomic’ analysis and ‘gene sequencing’, a “full picture” of all kinds of organisms—bacterial, fungal, viral and others—can be monitored. “Wastewater reveals the truth and even if the clinical symptoms are mild and therefore no reporting, we can find what pathogens are circulating among the people,” he said.

COVID-19 experience had helped scientists standardise protocols and there are indigenous diagnostics kits available for testing samples for AMR as well as other communicable diseases. “The challenge is to come out with indigenous surveillance kits for which we are working with small firms for developing them,” he explained.

With the help of Rockefeller Foundation grant of about $9.5 million, in four city clusters—Bengaluru, Hyderabad, Pune and Delhi—a huge effort is being put into wastewater surveillance for the past one-and-a-half years. The major objective is to establish robust protocols, indigenise the reagents/consumables required and also create capacity for human resource/training and spreading awareness.

“We expect to have a common website soon for better communication. It can also serve as a public outreach to educate the people and avoid misuse of antibiotics. Cities like Gandhinagar and a few other places across the country are also doing good work independently with the support of local governments or centrally funded projects,” said the top scientist.

Coordinated approach needed

“Ideally, it will be better to have a coordinated approach with data sharing and analysis of pathogen surveillance since people are always on the move. With the World Health Organisation (WHO) through its International Pathogen Surveillance Network (IPSN) and the Central government too keen on one health and pathogen surveillance through sewage, it is very much possible to have a public-private partnership (PPP) mode with suitable privacy checks,” said Dr. Mishra.

Effective environmental surveillance would go a long way in identifying the resistant genes to specific antibiotics and perhaps, prevent overuse or stop usage for a considerable period of time to prevent obsolescence. With climate change and environmental degradation, the rate of emerging pathogens affecting humans has become high. Therefore, constant monitoring has become imperative before another pandemic hits, he averred.