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Exploring Auckland's sewers for antibiotic-resistant superbugs

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Antimicrobial susceptibility in a petri dish

The rise of antibiotic-resistant superbugs could make routine surgery and medical treatments life-threateningly risky, but just how widespread the problem is in New Zealand remains unknown.

A new pilot study announced today will delve into Auckland’s sewer network to quantify and map levels of antibiotic resistance in the community, allowing researchers to estimate levels of resistance in healthy, asymptomatic individuals as well as in those who are unwell. If successful, a similar technique could be used to map viral outbreaks such as the current coronavirus crisis at a regional level.

Associate Professor Siouxsie Wiles MNZM from the University of Auckland has received a Health Research Council (HRC) Explorer Grant to carry out this novel research. She says New Zealand currently monitors antibiotic-resistant bacteria by analysing samples collected from hospital and community laboratories. Although this is a tried and true system, she says its main drawback is that it fails to capture information about resistant bacteria carried by healthy people with no symptoms.

“So far studies looking at antibiotic-resistance use samples taken from people who have been to the doctor or hospital. We don’t have a clear idea of what superbugs are out there in the general public,” says Associate Professor Wiles. 

“Healthy people can harbour some of these superbugs in their nose or gut and be absolutely fine. However, one day they might end up needing surgery and perhaps that organism will end up in their bloodstream where it will become very difficult to treat. Or they could inadvertently pass it on to someone else.” 

“Our study aims to understand what organisms are out there in communities without taking a nasal swab or a faecal sample from every single person because that’s just not feasible,” she says.

The study will sample hospital effluent and compare that to samples from wastewater treatment plants serving ‘healthy’ communities without a primary care facility in the catchment area. A variety of different testing methods will be used to see which achieves the best result – for example, trying to identify the antibiotic-resistant bacteria themselves, looking for genetic material from the bacteria (similar to the test for COVID-19), or using a more ‘shotgun’ sequencing approach where all material in the sample is sequenced to see what is present. It is possible that the researchers end up with an archive of samples that could be analysed for all sorts of pathogens, not just antibiotic-resistant bacteria.

While the data gathered would not be able to pinpoint individuals carrying antibiotic-resistant bacteria and resistance genes, it could be used to model and map outbreaks at a neighbourhood level, something Associate Professor Wiles is wary of.

“One of the key things we want to determine through this study is at what scale is it appropriate to go down to. Just because we have the technology to model the level of antibiotic-resistant genes down to a neighbourhood level, it does not necessarily mean that we should. We are acutely aware of the need to carry out this work safely and ethically so that it doesn’t stigmatise communities or perpetuate inequalities.”

HRC Chief Executive Professor Sunny Collings says the information gathered from this study could give clinicians advance notice of which antibiotics are going to work on their patients and which are not, saving vital time – and possibly lives. It could also help public health officials make better informed decisions on where infection control policies would best be applied – policies that are crucial for preventing infections in vulnerable patients as well as those undergoing routine surgeries such as knee or hip replacements.

“The World Health Organization has called for drastic action to avert a return to the pre-antibiotic era. It’s becoming more and more difficult and expensive to treat people who have antibiotic-resistance, and while we aren’t yet seeing widespread deaths globally like we’re currently experiencing with the COVID-19 pandemic, it will happen at some point if we don’t tackle it head on,” says Professor Collings.

Associate Professor Wiles’ study is one of 17 Explorer Grants announced today by the Health Research Council worth a combined total of $2.55 million. The grants support innovative and transformative research, and are an example of cutting-edge, higher-risk investment. See below for the full list of 2020 Explorer Grant recipients. To read lay summaries about any of these research projects, go to hrc.govt.nz/resources/research-repository and filter by proposal type ‘Explorer Grants’ and year ‘2020’.

2020 HRC Explorer Grant recipients

Dr William Abbott, Auckland DHB Charitable Trust 
HBsAg mutations and pathophysiology of chronic hepatitis B
24 months, $150,000

Professor Michael Berridge, Malaghan Institute of Medical Research 
Early mitochondrial dysfunction assay for neurodegenerative diseases 
24 months, $150,000

Dr Louise Bicknell, University of Otago 
Is our destiny in our genes? Using Mendelian genetics to refine cancer risk 
24 months, $150,000

Professor Antony Braithwaite, University of Otago 
Overcoming the limitations of adoptive T-cell therapy by genetic modification 
24 months, $150,000

Dr Stephanie Dawes, The University of Auckland 
Designing synergistic combinations to prevent antibiotic resistance 
24 months, $150,000

Dr Ian Goodwin, Massey University 
Instagram influencers, unhealthy products, and covert marketing to young people 
24 months, $150,000

Dr Meghan Hill, The University of Auckland 
The placental clock: Investigating mechanisms of stillbirth 
24 months, $150,000

Dr Haribalan Kumar, The University of Auckland 
Continuous dynamic monitoring of lung function at the bedside 
24 months, $150,000

Dr Benjamin Lawrence, The University of Auckland 
A collaborative AR work and presentation tool to examine tumour evolution 
24 months, $150,000

Dr Danielle Lottridge, The University of Auckland 
Codesign of augmented reality stroke rehabilitation from Te Whare Tapa Whā 
24 months, $150,000

Associate Professor Alexander McLellan, University of Otago 
Fighting splicing with splicing: New strategies for CAR T cell immunotherapy 
24 months, $150,000

Professor Anthony Phillips, The University of Auckland 
Lung protection during critical illness 
24 months, $150,000

Professor Anthony Phillips, The University of Auckland 
Looking skin deep 
24 months, $150,000

Dr Simone Rodda, The University of Auckland
Synthesis of a million stories with natural language processing 
24 months, $150,000

Professor Julia Rucklidge, University of Canterbury 
A community based RCT evaluating micronutrients for mood dysregulated teenagers 
24 months, $150,000

Associate Professor Siouxsie Wiles, The University of Auckland 
Sewers for superbug surveillance 
24 months, $150,000

Dr Lyn Wise, University of Otago 
Resurrection of an anti-inflammatory therapy through protein engineering 
24 months, $150,000