Combatting Antibiotic Resistance in Philippine lakes: One-health upstream interventions to ease the burden

When antibiotics are used in humans and animals some of the drug may be passed out into urine or faeces, or when delivered in feed and water to animals may run off into the environment. In both cases antibiotics and antibiotic-resistant bacteria may enter water courses such as lakes important as sources of water, for fishing, farming of fish and prawns and for leisure. This contamination may lead to the spread of antibiotic resistance. The development of resistance to key antibiotics is of concern in treating human infections. Fewer restrictions on the use of antibiotics in Asia mean this is a rapidly developing problem both from use in agriculture and medicine.

In this project we will assess how antimicrobial use in both humans and animals in Philippines leads to contamination of the large Laguna Lake in Luzon Island. We will then apply physical interventions such as waste water treatment and changes in practice (antimicrobial stewardship) in animals and assess changes to contamination. If successful these approaches can be used in other developing countries sin Asia, Africa and Latin America.

Lakes provide essential natural resources for populations in low-middle income countries. A growing concern has been their contamination with antimicrobial-resistant determinants from animal and human sources. Chief among these are Beta-lactam and carbapenem antimicrobials that are the cornerstone of human antimicrobial therapy. A growing literature supports that Beta-lactam resistance in Asian lakes and rivers is increasing. However, few interventions have been rigorously evaluated to see if environmental contamination from hospitals and agriculture can be reduced.
We will develop and deliver interventions to determine their impact on Beta-lactam resistance. Interventions include antimicrobial stewardship programs in hospitals and veterinary settings, campaigns to reduce the use of antimicrobials in backyard farms, and cleaning of effluents feeding the lake. Beta-lactam resistance in lake water will be quantified using methods such as chemical, genetic, and microbiome studies before and after key interventions. The One Health approach is essential to tackle antimicrobial resistance or antibiotic resistance in the human-animal-environment interface. The conditions in and around Laguna Lake in the Philippines ressemble those of many Latin American and African countries, allowing project results to be generalizable.
Lower pollution loads will improve water quality and lake resources, and reduce disease outbreaks, benefiting the lakeshore communities and the surrounding area of over 16 million people. The technologies developed are generalizable to other LMICs.