Drivers of Resistance in Uganda and Malawi (DRUM): a protocol for the evaluation of One-Health drivers of Extended Spectrum Beta Lactamase (ESBL) resistance in Low-Middle Income Countries (LMICs)

Cocker, Derek, Sammarro, Melodie, Chidziwisano, Kondwani, Elviss, Nicola, Jacob, Shevin ORCID: https://orcid.org/0000-0003-2425-9394, Kajumbula, Henry, Mugisha, Lawrence, Musoke, David, Musicha, Patrick, Roberts, Adam ORCID: https://orcid.org/0000-0002-0760-3088, Rowlingson, Barry, Singer, Andrew C., Byrne, Rachel, Edwards, Thomas, Lester, Rebecca ORCID: https://orcid.org/0000-0002-0259-9630, Wilson, Catherine, Hollihead, Beth, Thomson, Nicholas, Jewell, Christopher P., Morse, Tracy and Feasey, Nicholas ORCID: https://orcid.org/0000-0003-4041-1405 (2022) 'Drivers of Resistance in Uganda and Malawi (DRUM): a protocol for the evaluation of One-Health drivers of Extended Spectrum Beta Lactamase (ESBL) resistance in Low-Middle Income Countries (LMICs)'. Wellcome Open Research, Vol 7, e55.

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Abstract

In sub-Saharan Africa (sSA), there is high morbidity and mortality from severe bacterial infection and this is compounded by antimicrobial resistance, in particular, resistance to 3rd-generation cephalosporins. This resistance is typically mediated by extended-spectrum beta lactamases (ESBLs). To interrupt ESBL transmission it will be important to investigate how human behaviour, water, sanitation, and hygiene (WASH) practices, environmental contamination, and antibiotic usage in both urban and rural settings interact to contribute to transmission of ESBL E. coli and ESBL K. pneumoniae between humans, animals, and the environment.
Here we present the protocol for the Drivers of Resistance in Uganda and Malawi (DRUM) Consortium, in which we will collect demographic, geospatial, clinical, animal husbandry and WASH data from a total of 400 households in Uganda and Malawi. Longitudinal human, animal and environmental sampling at each household will be used to isolate ESBL E. coli and ESBL K. pneumoniae. This will be complimented by a Risks, Attitudes, Norms, Abilities and Self-Regulation (RANAS) survey and structured observations to understand the contextual and psychosocial drivers of regional WASH practices.
Bacterial isolates and plate sweeps will be further characterised using a mixture of short-,long-read and metagenomic whole-genome sequencing. These datasets will be integrated into agent-based models to describe the transmission of EBSL resistance in Uganda and Malawi and allow us to inform the design of interventions for interrupting transmission of ESBL-bacteria.

Item Type:	Article
Subjects:	QW Microbiology and Immunology > Bacteria > QW 138 Enterobacteriaceae QW Microbiology and Immunology > QW 45 Microbial drug resistance. General or not elsewhere classified. WA Public Health > WA 30 Socioeconomic factors in public health (General) WA Public Health > Health Administration and Organization > WA 540 National and state health administration
Faculty: Department:	Biological Sciences > Department of Tropical Disease Biology Clinical Sciences & International Health > Clinical Sciences Department Education
Digital Object Identifer (DOI):	https://doi.org/10.12688/wellcomeopenres.17581.1
Depositing User:	Marie Hatton
Date Deposited:	03 Mar 2022 15:17
Last Modified:	03 Mar 2022 15:17
URI:	https://archive.lstmed.ac.uk/id/eprint/20015

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