Study protocol for One Health data collections, analyses and intervention of the Sino-Swedish integrated multisectoral partnership for antibiotic resistance containment (IMPACT)

Abstract

IntroductionTo effectively minimise the emergence and dissemination of antibiotic resistant bacteria, a holistic One Health approach is called for. The Sino-Swedish Integrated Multisectoral Partnership for Antibiotic Resistance Containment is a cross-sectoral and integrated project on antibiotic resistance, conducted in Shandong Province in China. This paper outlines the overall study protocol for the project. To our knowledge, this is the first research programme aiming to take a true holistic approach across multiple sectors simultaneously in China, and the first to incorporate both antibiotic use and infection prevention and control in addition to antibiotic resistance patterns. The project aims to address gaps in current knowledge and seeks to improve the situation through a system-wide intervention. By using a One Health approach we can address important research questions that individual discipline investigations are unable to. The results obtained should thus more closely reflect the world in which human health, animal health and the environment are inextricably and intimately interlinked.Methods and analysisBoth quantitative and qualitative studies are included for households from 12 villages, their surrounding environment and a tertiary care hospital in a nearby town. The studies include analyses of antibiotic consumption for humans and pigs; qualitative and quantitative data on perceptions, knowledge and attitudes; faecal carriage of extended spectrum β-lactamase and carbapenemase-producing Enterobacteriaceae from pigs and humans, and occurrence in household drinking water, surface water, waste water and clinical bacterial isolates from the hospital. Carriage of methicillin-resistant Staphylococcus aureus in humans, household pigs and clinical bacterial isolates is also investigated. Furthermore, potential inter-relationships between these sources are analysed. A multifaceted One Health intervention is designed and implemented in 6 of the 12 villages. Repeated and continuous data collections take place over 2 years, where the repeated data collection is performed after 1 year of intervention. Comparisons are made between intervention and control villages, before and after the intervention.EthicsEthics approval was obtained from the first Affiliated Hospital, College of Medicine, Zhejiang University, China, reference number 2015#185 and 2015#283.

Characterization of Clinically Relevant Strains of Extended-Spectrum β-Lactamase-Producing Klebsiella pneumoniae Occurring in Environmental Sources in a Rural Area of China by Using Whole-Genome Sequencing

“…Samples were collected in a rural area of Shandong Province, China, in July 2015 (Figure 1). Details of the sampling procedure have been described elsewhere (Sun et al, 2018). Pig manure, wild bird feces, vegetables (cucumber, beans, and chives), and environmental samples were collected with ESwab tubes (Copan, Brescia, Italy) from the study villages.…”

Mobile colistin resistance gene mcr-5 in porcine Aeromonas hydrophila

“…The village and household selection methods have been described previously. 12 All samples were enriched in 1 mL of LB broth containing 10 mg/L vancomycin at 37°C overnight. Total DNA was extracted from 500 μL of each of the enriched cultures using a Wizard Genomic DNA Purification Kit (Promega, Madison, WI, USA) and the DNA used for screening of mcr-5 by PCR, as previously reported.…”

Variations in antibiotic prescribing among village doctors in a rural region of Shandong province, China: a cross-sectional analysis of prescriptions

“…This county is in the middle level in Shandong province in terms of economics, health indicators and population size. As previously described in the full study protocol, 12 the county and town were first selected based on the requirements and design of the IMPACT research programme, in particular being broadly representative of rural Shandong province, and including the presence of local collaborators who were capable of providing administrative support throughout the entire duration of the research programme. Twelve villages were then purposively selected around the town from among 17 that had at least 100 households.…”

“…Our study forms part of a large cross-sectoral research programme on antibiotic consumption and resistance involving Chinese and Swedish researchers, the Sino-Swedish Integrated Multisectoral Partnership for Antibiotic Resistance Containment (IMPACT). 12…”