Does AMR in livestock contribute to AMR in people in NE India? An interdisciplinary study.

Considerable amounts of antibiotics are used in the rearing of livestock and the use of these antibiotics leads to the selection of bacteria that are resistant. There is some evidence that these bacteria may contribute to resistance levels in bacteria that cause human disease. This research aims to investigate if antibiotic resistant strains of bacteria found in farms are also found in cases of human disease in a region of North East India. This project will also record the use of antibiotics on farms, and to investigate the human behavioural and animal health factors that influence antibiotic use. The study combines microbiological and social science research methods. Agriculture in this area consists mainly of smaller livestock enterprises typical of many rural settings in India. The aim is to provide a comprehensive description of the distribution of resistant bacteria in humans, livestock (including aquaculture) and the environment together with a thorough study of the context which leads to the selection of these bacteria in order to understand which antibiotics (and the quantities) are used and why. The project also aims to increase the research capacity in India to continue this work through increased experience and training in the application of DNA sequencing and social science methods for research into antibiotic resistance.

The specific research work that will be performed is:

1. Sampling on farms in order to bacteria from animals, people, the environment and retail meat products, together with bacteria from cases of human disease from local hospitals.

2. Collection of data from farms to record antibiotic use, how and why decisions are made to use antibiotics, which individuals are influencing these decisions, and what factors affect the decision-making process (to include how presumptive diagnoses are made, societal hierarchy, prior knowledge, education, attitudes, and economic factors) using established social science research methods .

3. DNA sequencing of the bacteria in order to characterise the mechanisms responsible for antibiotic resistance, and to compare the relatedness of agricultural and hospital bacteria. This enables us to determine if there is transmission of antibiotic resistance from farm animals to people.

4. To develop antibiotic stewardship advice, materials and programmes that are tailored to a rural Indian context in order to maximise animal health and ensure rational use of antibiotics.

Good quality scientific evidence is needed to ensure that any restrictions on antibiotic use on farms are rational, and targeted appropriately. Regardless of any contribution to human antibiotic resistance better antibiotic stewardship in agriculture will reduced levels of resistance in livestock and lead to improved animal health.

The impact from this research will result from the answer to the question "Is antibiotic resistance transmitted to man from livestock?". If it is we will also identify the bacterial species and types of resistance that are involved. This evidence is essential if there are to be informed decisions concerning efforts to control the use of antibiotics on farms. Our research is likely to identify specific routes of transmission (i.e. via farm workers, environmental reservoirs, retail food products etc) which would enable the development of risk assessment models and the design of interventions where the risks are highest. The research will identify how much antibiotic is being used on farms and the reasons why it is being used which in turn will enable the identification of ineffective or inappropriate antibiotic use. This information will help in the design of targeted antibiotic stewardship programmes that address the barriers to rational antibiotic use that are specific to the rural agricultural settings in India.

Social and economic benefits will accrue. A reduction in antibiotic resistance in human disease will lead to more effective and timely treatment of infectious disease with patients returning to work more rapidly and leading to lower healthcare costs. Improved animal health will lead to greater agricultural productivity and reductions in the economic losses associated with infectious disease. As farm incomes make a major contribution to rural family incomes with limited economic resources, better economic performance will lead to a reduction in poverty.