Dynamics of Antimicrobial Resistance in the Urban Water Cycle in Europe

Lead Research Organisation: Newcastle University
Department Name: Sch of Engineering

Abstract

Resistance of pathogenic bacteria to antibiotics and other antimicrobials is increasing everywhere on Earth. This is making progressively our current antibiotics useless, potentially placing patient's lives at risk as some can no longer be treated by available treatment options. Resistance is not only selected inside the human body when antibiotics are used to treat people, but also selected after the antibiotics from patients in hospitals or ill people at home are entering the sewage. Moreover, the resistance genes can transfer to other bacteria, where they can persist and eventually transfer back to pathogenic bacteria. This transfer also happens in the sewage.

We postulate that urban water systems, that is, sewers, sewage treatment plants and receiving waters, are central places of exchange of resistance genes between pathogenic bacteria and environmental bacteria because these systems continuously receive excreted antimicrobials, resistant bacteria and resistance genes from many sources. Further, the high numbers of bacteria in these systems increases the transfer of resistance genes between different bacteria. The mixing of different wastes (e.g., hospital and community sewage) increases the selection for bacteria carrying multiple resistance genes due to the simultaneous presence of various antibiotics, biocides, and heavy metals.

DARWIN (Dynamics of Antimicrobial Resistance in the Urban Water Cycle in Europe) will be the first project to perform a cross-European examination of the fate of key resistant bacteria and resistance genes in UWSs resulting from discharged hospital and community wastes, including mechanisms of resistance gene transfer in different stages of sewer catchments and receiving waters. We will focus on the spread of resistance genes that are amongst the most problematic now because they confer resistance to the latest generation of antibiotics available (genes for extended spectrum beta-lactamases (ESBL) and carbapenemases). Specifically, we will investigate these resistance classes in three countries that differ in their use of antibiotics and sewage management practices: Denmark, Spain and the UK. We postulate that resistance genes readily transmit in urban water systems from pathogenic and non-pathogenic "gut" bacteria in human wastes (after antibiotic use) to environmental bacteria better adapted to the sewer environment. The environmental bacteria then carry the resistance genes across the wider environment, increasing community exposure.

Hence, we will, for the first time, determine which specific bacteria carry the resistance genes across the urban water systems and identify where resistance gene transfer events occur. Our ultimate goal is to assess the relative risk of resistance genes returning back to humans due to environmental exposure. To guide risk assessments, a predictive dynamic mathematical model for the urban water systems will be developed to assist in health and sewage management decisions.

Technical Summary

While therapeutic antibiotic use directly impacts the evolution of AntiMicrobial Resistance (AMR), it has become increasingly clear that the environmental dimension of AMR is also of great importance. We postulate that urban water systems (UWS), which are our receptacle for excreted antimicrobials, AMR organisms and AMR genes, are central conduits of AMR to and from pathogens and environmental strains. This is because of high microbial densities and the co-mingling of different wastes, which promotes accelerated AMR gene transfer (HGT) and multi-resistance due to the co-occurrence of antibiotics, biocides, metals and microbes.

In DARWIN, we will undertake a never-previously-performed pan-European examination of the fate of key AMR organisms and genetic determinants in UWSs resulting from discharged hospital and community wastes, including transmission mechanisms in different stages of sewer catchments and receiving waters. We focus on the spread of AMR genes encoding clinically relevant extended spectrum b-lactam (ESBL) and carbapenem resistance in three countries with differing AMR profiles and sewage management practices. We posit that AMR genes readily transmit in UWSs from pathogens and commensal hosts in human wastes (after antibiotic use) to environmental strains better adapted to migrate through the sewer environment, which is driven by local ecologies, conjugal plasmid transfer and phage-mediated transduction.

Hence, we will, for the first time, determine specific bacterial hosts that carry AMR genes across UWSs, and identify where key HGT events occur with the ultimate goal of assessing the relative risk of AMR genes returning back to humans due to environmental exposure to AMR in urban environments. To guide risk assessments, a predictive dynamic mathematical model for UWSs will be developed to assist in health and sewage management decisions.

Planned Impact

Our project combines diverse expertise and access to urban water systems in three different countries to quantify patterns, pathways and mechanisms that drive AMR dissemination in urban environments. Central to project impact will be active involvement of our three industrial partners (major water companies in the UK, Denmark and Spain); our international External Advisory Board (EAB); and our strong links with European-wide AMR surveillance networks. Through these partners and connections, DARWIN has clear pathways to influence national, European and international policy. Specifics include:

i) Water industry partners: Active industrial partners are Northumbrian Water Ltd (NWL, UK), VIAQUA S.A. (ESP), and VandcenterSyd Denmark (VCS, DK). All three companies will provide complete cooperation, including access to their catchments and long-term data sets. However, each partner also has proactive relationships with their public and private stake-holders, and each will use their channels to support DARWIN outreach activities. For example, industrially-supported PhD students will be promoted and each company will help champion wider water issues within each national industry network.

ii) Industry impacts beyond project partners: Through each active partner, DARWIN will have wider influence across the EU water industry. For example, VIAQUA is active across Europe, having offices in ten countries. VIAQUA's philosophy is to invest in innovation to improve access to clean water, which they espouse across their corporate network. As such, DARWIN via VIAQUA will have pan-European influence, including water industries in countries outside of DARWIN. Further, NWL is an active partner in UKWIR; a research network spanning all UK water companies. UKWIR brokers novel approaches to wastewater management, which provides a path for DARWIN to impact the whole UK water industry. Finally, Danish colleagues have active collaborations with BIOFOS (the organisation responsible for sewage treatment across Copenhagen), and Veolia Water (FR), which is among the largest water companies in the world, creating global influence.

iii) Impact through the EAB: Our EAB includes Prof R Singer (US Presidential Advisory Committee on ARB), Prof Y-G Zhu (Director of the Chinese Academy of Science Institute of the Urban Environment), and Prof FB Mochales (Director of Instituto Ramon y Cajal de investigación Sanitaria). All three advisors are influential leaders on links between environmental and clinical AMR, and health in their countries. They provide a direct path for DARWIN to guide AMR decisions in each country and across the EU, which are all influential to global AMR policy.

iv) AMR awareness networks: DARWIN will link with ECDC, COMBACTE and EPI-NET under the new drugs for bad bugs - ND4BB program, ESCMID and its affiliated study groups on Antimicrobial Resistance Surveillance; Food- and Water-borne Infections; and Epidemiological Markers. These leading epidemiological networks on AMR will expand the impact of our project, including contextualising DARWIN efforts to help combat AMR spread in Europe.

v) The public-at-large: DARWIN will be use Press Offices of each academic partner to promote results to their local and national press, stakeholder organisations, and public interest groups. We have a strong track record in the public access to AMR work, including coverage on BBC World News and Danish TV, especially the role of the environment on AMR in healthcare systems. To further promote access, a multi-lingual webpage will be developed as well as a regularly updated Twitter feed, which allows rapid dissemination of outputs. We will, however, pay careful attention to reporting of results so as not to create undue concern about AMR detected during the work. Finally, Citizen Science will be encouraged throughout he project via access to our webpage, including an "invitation to share and collaborate" on the wider use of our databases.

Publications

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Lamba M (2018) Carbapenem resistance exposures via wastewaters across New Delhi. in Environment international

 
Title AMRflows logo and graphic 
Description We have designed a logo and graphic for the new AMRflows project 
Type Of Art Image 
Year Produced 2020 
Impact We are using this on our project twitter account and website and will be using it in presentations. 
URL https://more.bham.ac.uk/amrflows/
 
Description Citation to research in the US CDC and Wellcome Report on AMR
Geographic Reach Multiple continents/international 
Policy Influence Type Citation in other policy documents
URL https://wellcome.ac.uk/sites/default/files/antimicrobial-resistance-environment-report.pdf
 
Description Defra workshop on antimicrobial resistance in the environment
Geographic Reach National 
Policy Influence Type Participation in a advisory committee
 
Description Initiatives for Addressing Antimicrobial Resistance in the Environment: Current Situation and Challenges. Prepared for U.S. Centers for Disease Control and Prevention, the UK Science & Innovation Network, and the Wellcome Trust [co-authored by D Graham]aham
Geographic Reach Multiple continents/international 
Policy Influence Type Implementation circular/rapid advice/letter to e.g. Ministry of Health
Impact Key points taken from report Executive Summary: • Antimicrobial resistance (AMR)-when microbes (i.e., bacteria and fungi) develop the ability to defeat the drugs designed to combat them-is a public health threat and global priority. Resistant pathogens can cause infections in humans that are difficult or impossible to treat. • Scientific evidence shows that antimicrobials and antimicrobial-resistant microbes are present and can persist and travel (spread) through the environment (waterways and soils). Human activity can contaminate the environment with antimicrobials and antimicrobial-resistant microbes, which can accelerate the development and spread of resistance. • Contamination can occur from human and animal waste, pharmaceutical manufacturing waste, and use of antimicrobial pesticides for crops; however, the scale and risk associated with this contamination is not fully understood. There are outstanding scientific questions related to the presence and impact of antimicrobial-resistant microbes in the environment and the direct risk posed to human health. • The environment is a key element of the One Health framework. It is necessary to better understand risks, prioritize action to address antimicrobial-resistant microbes in the environment where potential risks to human health are greatest, and cultivate a collaborative global approach. • Scientific review suggests that there are actions that could improve understanding and guide action: - A better understanding of hospital waste treatment in different global settings is a priority, requiring establishment of evidence-based waste standards and implementation of effective waste management practices and capabilities where interventions are most needed. - Good hygiene and sanitation, including effective waste disposal and treatment, are important ways to mitigate the risk of antimicrobial-resistant microbes in the environment associated with human waste and wastewater contamination. - When feasible, contamination by animal waste could be reduced by improving antimicrobial use, developing alternative disease control methods (e.g., vaccines), and improving the quality of the rearing environment to help reduce the need for antimicrobials. - Agreement on a discharge limit for effluents leaving manufacturing sites and standardized monitoring and reporting of effluent levels could significantly reduce contamination and potential human health risks associated with exposure to resistant microbes in the environment. - Potential risks from using antimicrobials on crops could be reduced through greater global transparency of antimicrobial use, implementation of best management practices when applying antimicrobials as pesticides, and greater use of alternative disease prevention and treatment strategies. • To maximize potential impact, align activities to address antimicrobial-resistant microbes in the environment (e.g., addressing knowledge gaps) with existing global public health and development efforts, such as Sustainable Development Goals; the Water, Sanitation and Hygiene Initiative; and the Global Health Security Agenda.
URL https://wellcome.org/sites/default/files/antimicrobial-resistance-environment-report.pdf
 
Description Technical brief on water, sanitation, hygiene and wastewater management to prevent infections and reduce the spread of antimicrobial resistance. Published by World Health Organization, Food and Agriculture Organization of the United Nations, and World Organisation for Animal Health [D Graham co-author]
Geographic Reach Multiple continents/international 
Policy Influence Type Implementation circular/rapid advice/letter to e.g. Ministry of Health
Impact This document defines the six Action Areas that need to be addressed to reduce global AMR, especially in LMICs via full WaSH implementation. The Technical Brief has been translated into six languages so far and is underpinning One Health solutions to AMR around the world.
URL https://www.who.int/publications/i/item/9789240006416
 
Description WHO AMR WASH Policy
Geographic Reach Multiple continents/international 
Policy Influence Type Implementation circular/rapid advice/letter to e.g. Ministry of Health
 
Description WHO/FAO/OIE Policy linking WASH Implementation and AMR Mitigation
Geographic Reach Multiple continents/international 
Policy Influence Type Membership of a guideline committee
Impact The policy provides evidence that implementing WASH and decentralised sanitation can reduce AMR spread in LMICs. The formal WHO/FAO/OIE Policy Brief has not yet become public (expected April 2020), but its content already has been shared with some governments and evident changes are occurring on the ground. One of the goals of the Brief is to provide a template for developing AMR National Action Plans, which was among key elements contributed by our work.
 
Description AMRflows: antimicrobials and resistance from manufacturing flows to people: joined up experiments, mathematical modelling and risk analysis
Amount £765,076 (GBP)
Funding ID NE/T013222/1 
Organisation Natural Environment Research Council 
Sector Public
Country United Kingdom
Start 11/2020 
End 10/2023
 
Description British Council and UK Science & Innovation Network UK-Israel SYNERGY Symposium
Amount £8,500 (GBP)
Organisation British Council 
Sector Charity/Non Profit
Country United Kingdom
Start 06/2017 
End 05/2018
 
Description EPSRC Bright Ideas Program
Amount £251,000 (GBP)
Funding ID EP/R036705/1 
Organisation Engineering and Physical Sciences Research Council (EPSRC) 
Sector Public
Country United Kingdom
Start 04/2018 
End 03/2020
 
Description EPSRC Institional Sponsorship Funds
Amount £18,000 (GBP)
Funding ID GCRF_IS_2017 
Organisation Engineering and Physical Sciences Research Council (EPSRC) 
Sector Public
Country United Kingdom
Start 10/2017 
End 03/2018
 
Description EPSRC Institutional Sponsorship Fund
Amount £17,000 (GBP)
Funding ID EP/R512692/1 
Organisation Engineering and Physical Sciences Research Council (EPSRC) 
Sector Public
Country United Kingdom
Start 10/2017 
End 03/2018
 
Description Embedding Antimicrobial Resistance (AMR) and Childhood Malnutrition Studies in South Asia into World Health Organisation (WHO) Policy
Amount £27,033 (GBP)
Organisation Newcastle University 
Sector Academic/University
Country United Kingdom
Start 03/2020 
End 12/2020
 
Description GCRF Water Security and Sustainable Development Award
Amount £17,100,000 (GBP)
Funding ID ES/S008179/1 
Organisation Economic and Social Research Council 
Sector Public
Country United Kingdom
Start 02/2019 
End 02/2024
 
Description Impact Acceleration Award
Amount £31,000 (GBP)
Organisation Engineering and Physical Sciences Research Council (EPSRC) 
Sector Public
Country United Kingdom
Start 09/2018 
End 07/2019
 
Description Newton Insititutional Award Program
Amount £80,000 (GBP)
Organisation Newton Fund 
Sector Public
Country United Kingdom
Start 04/2018 
End 03/2020
 
Description Quantifying Perceptions of Antibiotic Resistance and its Causes to Promote Decentralised Wastewater Treatment
Amount £14,700 (GBP)
Organisation Engineering and Physical Sciences Research Council (EPSRC) 
Sector Public
Country United Kingdom
Start 07/2019 
End 03/2020
 
Description University of Birmingham Institute for Global Innovation (IGI) development theme
Amount £60,000 (GBP)
Organisation University of Birmingham 
Sector Academic/University
Country United Kingdom
Start 02/2018 
End 01/2021
 
Title Developed AMR source tracking bioinformatics tool 
Description Traditionally HT-qPCR (resistomes) and 16S sequencing (microbiomes) data are analysed independently, but we have developed a new method for overlaying the functional gene and bacterial genotype datasets, respectively, to stochastically align AMR gene data to specific bacteria and their original source. This is being used to identify sources of AMR in catchments, which includes wastewater sources. The method is being tested in a number of projects. 
Type Of Material Technology assay or reagent 
Year Produced 2019 
Provided To Others? Yes  
Impact The method is described in a manuscript, which is currently under academic peer review (as of April, 2019). We are optimistic the will become public in summer 2019. Once published, we expect impact will be significant because it will provide a new way of linking specific waste sources to downstream human exposures. 
 
Description Development of new resistance gene arrays for screening wastewater 
Organisation Michigan State University
Country United States 
Sector Academic/University 
PI Contribution We worked with Michigan State University to refine and modify their resistance gene array for performing High-Throughout qPCR of wastewater samples in the project. Their previous array quantified 280 resistance genes across 19 classes of antibiotics, but coverage in each resistance class was thin. We helped them refine their array to focus on resistance genes of particular medical relevance, including ESBL and carbapenem resistance. The new array includes 60 genes, but has expanded ESBL and carbapenem resistance coverage from eight genes to 60. To our knowledge, the new array is the only method for precisely quantifying this many ESBL and carbapenem resistance genes simultaneously, and we are now using the array and this partnership on all our AMR projects around the world. A slightly modified version of this array is now being trialled using samples from the Newton Institution award.
Collaborator Contribution They had the technology, but their array was non-specific. Based on our guidance, they rebuilt and modified their array for our use and also the use of others interested in ESBL and carbapenem resistance. We are now testing the array in a number of our international projects, including the Newton Institutional award and also just starting on the large GCRF Hub project.
Impact Not yet, but soon.
Start Year 2017
 
Title New treatment core for Dentrifying Downflow Hanging Sponge (DDHS) reactors 
Description The patent application has just been submitted and the paperwork is complete. DDHS are among the options available for local-scale waste treatment in locations like rural Malaysia. The optimised core allows the reactor remove Total Nitrogen, AMR genes and infectious disease from wastewater in a highly effective manner at local scales. No other technology has been proven to do this. Further data to confirm the value of the technology is being gained in the Newton Institutional and other awards. 
IP Reference Not available yet 
Protection Patent application published
Year Protection Granted 2019
Licensed Commercial In Confidence
Impact None yet. However, we are currently negotiating the scale up of the technology being tested in the Newton award to full-scale, both in Malaysia and also in India.
 
Description Decentralized WASH Systems to combat Antimicrobial Resistance (AMR) workshop (Colombo, Sri Lanka) - David Graham 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact This workshop was presented on behalf of the World Health Organisation. It was held at the IWA Sustainable Development Congress & Exhibition in Colombo (Sri Lanka) to inform and guide practitioners in the water industry about their critical role in reducing AMR via improved water quality. Graham, and two colleagues from IWMI (Sri Lanka) and RIVM (the Netherlands), respectively, presented the workshop, which informed the audience of future guidance from the WHO.
Year(s) Of Engagement Activity 2019
 
Description 'Superbug gene' found in one of the most remote places on earth 
Form Of Engagement Activity A press release, press conference or response to a media enquiry/interview
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Public/other audiences
Results and Impact Newcastle University Press Release. 28 January 2019. This release matched the storyline presented in the 29 January 2019, Antibiotic resistant 'superbug' genes found in the High Arctic, piece in The Conversation.
Year(s) Of Engagement Activity 2019
URL https://www.ncl.ac.uk/press/articles/archive/2019/01/arcticbugs/
 
Description Adviser and co-author of new WASH guidance from the World Health Organisation relative to AMR - David Graham 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Policymakers/politicians
Results and Impact As a result of working with the US CDC, Graham was invited to advise and co-write WASH guidance. The guidance document is currently in revision (as of 02/19) with a planned publication date of 05/19. Our role was to write sections on the value of incremental sanitation improvements to reduce AMR and infectious disease. Our work was informed by all our prejects that relate environmental AMR and contaminated soils and water.
Year(s) Of Engagement Activity 2018,2019
 
Description Annual Graham Group Newsletter 
Form Of Engagement Activity A magazine, newsletter or online publication
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Other audiences
Results and Impact Annual Graham Research Group newsletter available online and set as a pdf to interested parties. It highlight the group's research efforts and compliments the group's research blog. It provides a condensed version for our funders, research partners, university colleagues, alumni, and students as well as friends and family.
Year(s) Of Engagement Activity 2020,2021
URL https://blogs.ncl.ac.uk/grahamr/?page_id=31
 
Description Antibiotic resistant 'superbug' genes found in the High Arctic 
Form Of Engagement Activity A magazine, newsletter or online publication
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Public/other audiences
Results and Impact The article, presented in a layman terms, revealed the discovery of antibiotic-resistant genes in the High Artic and presented an explanation of how this finding has huge implications for global antibiotic resistance spread.
Year(s) Of Engagement Activity 2019
URL https://theconversation.com/antibiotic-resistant-superbug-genes-found-in-the-high-arctic-110636
 
Description Antimicrobial resistance in the environment of emerging countries [Amelie Ott] 
Form Of Engagement Activity A broadcast e.g. TV/radio/film/podcast (other than news/press)
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Other audiences
Results and Impact Stop-motion film entry for the Institute for Social Science Post Graduate Researcher Impact Award 2019. Awarded third place. It was posted on YouTube for 18 months but has since been made private by the creator Amelie Ott.
Year(s) Of Engagement Activity 2019
 
Description CARe response to Parliamentary Inquiry 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Policymakers/politicians
Results and Impact Contributed as part of the CARe team of the University of Birmingham's Institute for Global Innovation (IGI) to a response to a Parliamentary Inquiry on the Government's AMR strategy renewal.
Year(s) Of Engagement Activity 2018
 
Description Calls for action now to prevent next global pandemic 
Form Of Engagement Activity A press release, press conference or response to a media enquiry/interview
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Public/other audiences
Results and Impact Newcastle University Press Office. 12 June 2020. Accouchement the accompany the Conversation piece that call for greater international co-operation to bring about improved water, sanitation and health provision as a way to prevent the next global pandemic
Year(s) Of Engagement Activity 2020
URL https://www.ncl.ac.uk/press/articles/latest/2020/06/amractionnowtopreventnextpandemic/
 
Description Co-author of the whitepaper on global led by the US Center for Disease Control - David Graham 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Policymakers/politicians
Results and Impact The draft whitepaper was prepared for April 2, 2018. Graham was the oral spokesman on proposed whitepaper mitigation strategies related domestic and hospital waste management at the international forum in Vancouver on April 4 and 5. This event had 150 policymakers from around the world, representing over 40 countries. The final whitepaper was published in December 2018, which consolidated the Vancouver meeting and was released to the WHO and all governments that have contributed to the forum.

The report was entitled "Initiatives for Addressing Antimicrobial Resistance in the Environment: Current Situation and Challenges" and was published on the Wellcome Trust webpage. A component of the whitepaper related to rural sanitation was informed by the Newton Institutional award, using new data collected from Malaysia.
Year(s) Of Engagement Activity 2017,2018,2019
URL https://wellcome.ac.uk/sites/default/files/antimicrobial-resistance-environment-report.pdf
 
Description Expert panel and co-writer of whitepaper sponsored by the Sackler Instuitute for Nutrition and New York Academy of Science - David Graham 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Policymakers/politicians
Results and Impact Graham is working as co-author and expert advisor in developing an integrated One Health strategy for reducing antimicrobial resistance in the animal food production industry. Initial meetings are occurring now (March 2018 to March 2019) with the goal of an international launch for proposed strategies in New York in April 2019.

Launch announcement can be found at https://www.nyas.org/events/2019/antibiotics-in-animal-agriculture-what-you-need-to-know/.
Year(s) Of Engagement Activity 2018,2019
URL https://www.nyas.org/events/2019/antibiotics-in-animal-agriculture-what-you-need-to-know/
 
Description Fighting the Next Pandemic: Water quality, antimicrobial resistance, and global health 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Other audiences
Results and Impact 2020 Newcastle University Alumni Day lecture. 10 October 2020
Year(s) Of Engagement Activity 2020
URL https://youtu.be/DB5aKt7YdD8
 
Description Ganges: sewers could be making water quality of India's great river worse [authors Milledge D and Bunce JT] 
Form Of Engagement Activity A magazine, newsletter or online publication
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Public/other audiences
Results and Impact The article touches on the fact that sewers may be making the Ganges water quality worse.
Year(s) Of Engagement Activity 2019
URL https://theconversation.com/ganges-sewers-could-be-making-water-quality-of-indias-great-river-worse-...
 
Description GrahAMR Research Group Blog 
Form Of Engagement Activity Engagement focused website, blog or social media channel
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Other audiences
Results and Impact The GrahAM Research Group blog highlights the work of the Graham research team, focusing primarily on work surrounding antimicrobial resistance (AMR), taking a collaborative and multidisciplinary approach to global health and well-being. The team of researchers, led by Newcastle University Prof David W Graham, utilises a holistic 'One Health Approach', and contributes to several of the UN's Sustainable Development Goals (SDGs).

Our research provides guidance to various international organisations, including the World Health Organisation, and bridges sustainable development, engineering, health, and sociotechnical mitigation options for reducing global AMR.

The main topics we explore are

the transmission, fate and impact of antibiotic resistance genes in the environment resulting from human activity;
energy minimization in water, wastewater and solid waste management systems;
the microbiology and ecology of greenhouse gas suppression and production in geochemical settings, especially in Polar regions; and
water and environmental quality in the developing and emerging world.
Year(s) Of Engagement Activity 2020,2021
URL https://blogs.ncl.ac.uk/grahamr/
 
Description India-UK team tackles antimicrobial resistance spread in waterways 
Form Of Engagement Activity A press release, press conference or response to a media enquiry/interview
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Public/other audiences
Results and Impact Newcastle University Press Office. 6 August 2020. Announced the launch of the AMRFlow project. Story picked up be various media outlets including: Hindustan Times, The Times of India, Deccan Herald, India Education Diary, The Times of Bengal, and The Week, India Inc.
Year(s) Of Engagement Activity 2020
URL https://www.ncl.ac.uk/press/articles/latest/2020/08/uk-indiaamrflows/
 
Description Keynote talk at the 27TH Meeting of the Spanish Society for Microbiology 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Postgraduate students
Results and Impact Keynote presentation at the special symposium at the Spanish Microbiology Society meeting on antimicrobial resistance )AMR). It brought experts from across Europe. Graham's presentation was on environmental AMR spread, including results from the Darwin, Sneaky Bacteria and other projects.
Year(s) Of Engagement Activity 2019
 
Description Lecture series in Paraguay - Marcos Baluja 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Policymakers/politicians
Results and Impact Dr Marcos Baluja was invited to provide a series of lectures and tutorials on environmental AMR in Paraguay related to work from the project. The series spanned August and September 2019, and included six lectures in medical, environmental and governmental agencies, but also meetings with senior politicians, including the the Minister of the Environment. An MOU between Newcastle University UNA in Asuncion, which will lead to mutual projects, and student and staff exchanges between the two universities.
Year(s) Of Engagement Activity 2019
 
Description Lecture tour of environmental and medical institutions in Israel - David Graham 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Provided a series of lectures at different organisations in Israel, including the Rambon Healthcare Center, the Technion University, The Hebrew University (in Rehovot), and at the Ben Gurian Desert Institute, all on AMR mitigation, especially blocking environmental pathways of spread. Audiences ranged from students to healthcare professionals to academics across disciplines. These have led to collaborative work on AMR spread, initially in Ethiopia. More impact would have been seen if the UK had not ceased their funding to the JPIAMR scheme.
Year(s) Of Engagement Activity 2019
 
Description Newcastle University Find Antibiotic Resistant Genes in Arctic 
Form Of Engagement Activity A broadcast e.g. TV/radio/film/podcast (other than news/press)
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Public/other audiences
Results and Impact Short film made available on the Newcastle University YouTube Channel. 28 January 2019. The content dovetails with the Antibiotic resistant 'superbug' genes found in the High Arctic in The Conversation and the 'Superbug gene' found in one of the most remote places on earth, Newcastle University Press Release on 28 January 2019.
Year(s) Of Engagement Activity 2019
URL https://www.youtube.com/watch?v=eDiIDkb4pDg
 
Description Presenting work on AMR dynamics on dairy farms at the UK dairy day 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Presenting results from the related NERC grant EVAL-FARMS on AMR dynamics on dairy farms to practicing dairy farmers and the dairy industry at the UK Dairy Day in Telford. We had many discussions with farmers at our stand and they were interested in our recommendation to store the slurry the longer the better before applying on fields.
Year(s) Of Engagement Activity 2019
 
Description Scientists around the world are already fighting the next pandemic 
Form Of Engagement Activity A magazine, newsletter or online publication
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Other audiences
Results and Impact Graham DW and Collignon P (9 June 2020 • 06:00 am) The Conversation.
Year(s) Of Engagement Activity 2020
URL https://theconversation.com/scientists-around-the-world-are-already-fighting-the-next-pandemic-11524...
 
Description Source tracking of antimicrobial resistance in emerging countries 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Supporters
Results and Impact Amelie Ott gave a webinar for the Royal Society of Public Health (RSPH) on 'Source tracking of antimicrobial resistance in emerging countries' with over 200 stakeholders registered for this event. Amelie talked about environmental antibiotic resistance in low-and-middle-income countries with a special focus on monitoring and modelling antibiotic resistance in South East Asian rivers. Amelie was invited to give this webinar after winning the student competition at the RSPH 'What is the future of water in public health?' conference in Sheffield, December 2019.
Year(s) Of Engagement Activity 2020
URL https://his.org.uk/training-events/external-events/what-is-the-future-of-water-and-public-health/
 
Description The Linkage between Wastewater, Health and Sustainable Sanitation 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Other audiences
Results and Impact Professor David Graham joins Professor Dato' Ir Dr Zaini Ujang (Secretary General to the Environment Ministry of Malaysia) and Professor Azmi bin Aris (Director of Centre for Environmental Sustainability and Water Security, Universiti Teknologi Malaysia) as panellists and moderator for this webinar. The webinar took place 17-19 August 2020.
Year(s) Of Engagement Activity 2020
URL https://youtu.be/wrZwTpseejY?t=393
 
Description Training Workshop on Mitigating antimicrobial Resistance (AMR) in the water cycle: Analytical methodologies and improving water quality - David Graham/David Werner 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Policymakers/politicians
Results and Impact We organised and led this workshop in association with four universities in Ethiopia, two universities in Israel, and members of the FAO and WHO. The goal was explain AMR in comparatively simple terms, and then promote new work in Ethiopia that bridges government, NGOs and academic groups in the country. It is also taught research methods.
Year(s) Of Engagement Activity 2019
 
Description Workshop on Pharmaceuticals in the Environment: Risks in low and middle income countries (Nairobi, Kenya) - David Graham 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Industry/Business
Results and Impact This was a think tank organised by AstraZeneca to discuss the impact of pharmaceutical pollutants in the environment in developing countries. It included experts from around the world, but also included representatives from NGOs, government agencies. The product of the workshop is a call for action, which is aimed at industry and governments around the world.
Year(s) Of Engagement Activity 2019
 
Description Workshop on the use of molecular biological methods for environmental research - David Graham 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact This workshop was for researchers and professional practitioners in Malaysia and Singapore. It taught how to collect environmental samples for molecular analysis, extract and purify DNA, quantify DNA signatures and then interpret data. The methods are now being using used by colleagues in Malaysia and Singapore. The course was taught by our group, but primarily by senior PhD students and junior PDRAs, both of which gained valuable experience from designing and delivering the course.
Year(s) Of Engagement Activity 2018