Resistomap Intelligence Platform for AMR data insights

Turning routine environmental AMR monitoring into simple insights: from wastewater samples to Resistomap Intelligence Platform for decision makers. Driven by molecular DNA-based technology, to generate comparable and standardised community-level data. Applying the One Health approach for seamless interoperability and expert communication.

Windi Muziasari, PhD CEO of Resistomap.

While the One Health approach is widely recognised as critical for tackling AMR, evidence suggests that its integration into AMR solutions is still insufficient. According to an analysis by the WHO in 2018, 93 countries had national action plans for AMR, however only 53 implemented a multi-sectoral human, animal and environmental approach. Collecting environmental AMR data would not only be useful to complete the picture of AMR levels from a One Health perspective, but also contribute to generating community-level AMR data, for example through wastewater surveillance.

As the first and frontrunner company for antibiotic resistance monitoring in the environment, Resistomap has analysed over 16,600 environmental samples spanning across 45 countries. 

However, nearly 75% of these samples were collected from Europe, with 18% from the Asian regions, and only a few percent from North America, Australia and Africa. With data discrepancy being a serious problem in LMICs, we are also committed to supporting AMR data creation and fair data ownership specifically within these regions. Additionally, current environmental AMR data sources come from limited data points rather than from routine monitoring, which does not produce an adequate and meaningful overview of the severity of AMR prevalence.

The matter of AMR concerns a wide network of actors, including decision makers, policy makers, AMR data scientists, researchers, funding agencies, and global One Health organisations. Resistomap identifies the need for an integrated One Health database for better interoperability, which is why we developed an Intelligence Platform that offers a visualised and integrated analysis representing the outcomes of our AMR monitoring service.

To map the needs of our initial target users, we maintain active engagement with potential users, experts and regulatory bodies. At the recent Innovation Workshop on water quality monitoring and assessment organised by multiple UN agencies, we met with AMR and water quality monitoring experts to use collective intelligence to solve for implementation challenges of routine surveillance of AMR in the environment and in the wastewater-environment interface (Cutrupi et al., 2024. Towards monitoring the invisible threat: a global approach for tackling AMR in water resources and environment [accepted for publication in Frontiers in Water on March 5, 2024]).

Our solution also focuses on data creation, knowledge, and skill transfer in lMICs, starting with Latin America. Where efficient surveillance methods are difficult to attain, we will introduce culture-independent, molecular surveillance methods, ensuring local partners have full analysed data ownership.

Resistomap’s Intelligence Platform revolutionises AMR monitoring by providing a sophisticated, community-level ecological health tool. It acts as an early warning system against antibiotic-resistant bacteria outbreaks, enhancing ecological and public health defences. Aimed at democratising data access, the platform offers inclusivity through a sustainable, user-friendly interface, envisioning a subscription model to evolve into a public good resource.

This initiative propels public health data generation for AMR mitigation market regulation, supporting informed decisions in routine monitoring, especially in wastewater, and addressing the interconnected sectors of the Water-Energy-Food-Ecosystem-Health Nexus. It aligns with Sustainable Development Goal 6, focusing on clean water and sanitation for all, seeking global endorsement for a robust reporting framework.

For LMICs, where reliance on culture-dependent methods is most prominent, our solution encourages a paradigm shift towards culture-independent and molecular methodologies. This shift is crucial for understanding the environmental spread of AMR. By providing LMICs with access to cutting-edge data, we empower local partners to make significant strides in AMR surveillance and management.

Beyond technology, Resistomap also produces public goods such as project impact assessments, evaluations, and reports, organising workshops for multidisciplinary AMR dialogue. This holistic approach integrates scientific, policy, and global health perspectives for a unified AMR response.

Resistomap plans to set new benchmarks for quantifying environmental AMR genes in LMICs, starting with Latin America as we do not have previous data in this region. The data, showcased on our Intelligence Platform, will help form actionable strategies to combat AMR, influencing decision-making and positively impacting ecological health.

Addressing AMR's ecological challenges, particularly for disenfranchised informal stakeholders and communities without influence over AMR management practices, is crucial. Resistomap's initiative to map AMR gene distribution in these areas aims to identify critical AMR strains, empowering communities dependent on their environment yet lacking direct change authority such as in animal husbandry practices and wastewater treatment operations.

This initiative is designed to forge a lasting impact, empowering those who rightfully interact with and depend on their environment but lack the authority to affect change directly. Resistomap aspires to bridge the gap between rightful environmental stewardship and effective AMR intervention, ensuring that communities are not only acknowledged but actively supported in the global fight against AMR. This effort strives to reconcile environmental stewardship with effective AMR intervention, ensuring community engagement in the global AMR fight and maintaining antibiotic efficacy, aligning with Sustainable Development Goals 3 and 6 for health and clean water.

Resistomap is leveraging its Intelligence Platform to catalyse transformative change in AMR mitigation and management, by facing challenges such as technical inaccessibility, unfair incentive structures, complexities in data ownership, and lax regulations. Over the next three years, we aspire to address these challenges by expanding the Platform to transcend its utility for AMR specialists, primarily aiming to enhance population-level health data interpretation. This transformation aims to empower policymakers and regulatory bodies, enabling them to forge direct connections between comprehensive AMR data insights and actionable health outcomes. This is anticipated to stimulate market regulations that incentivise more cohesive and comprehensive AMR management efforts, as our Platform serves as a simplified identification tool of AMR hotspots through a One Health lens with easy access to otherwise elusive databases.

Currently, our platform offers the latter, offering insights into regional AMR sources, albeit without the overtime data necessary for broader population health analyses. To address this, we plan to target LMIC markets facing export barriers due to antibiotic contamination, and offer tailored solutions. Preliminary correlations between clinical reports of vancomycin-resistant bacteria in Germany and our wastewater database indicators suggest promising progress towards achieving our primary objective of employing the platform for population health insights.

Our impact evaluation strategy currently focuses on quantifying environmental sample analyses, providing data on AMR in natural and wastewater environments. This data lays the groundwork for risk assessment and user experience enhancement, serving as a precursor to a more comprehensive monitoring framework. Initially, our measurement efforts are concentrated on the scope of impacted human and animal populations within agricultural settings. This early-stage monitoring is a critical step towards establishing a robust early warning system, addressing the current absence of large-scale AMR surveillance in wastewater systems, a crucial component of pandemic preparedness.

Regarding future metrics for impact assessment:

• Quantifying the proportion of clients who initiate AMR monitoring projects due to Resistomap's facilitation. We aspire to become the preeminent AMR Intelligence Platform, aggregating monitoring data from diverse sources to empower stakeholders - ranging from researchers and policymakers to healthcare providers and wastewater treatment facilities - in their fight against AMR, bolstering data-driven decision-making.

• Evaluating the share of projects that benefit from specific, data-driven AMR mitigation strategies recommended by our platform. By leveraging an extensive array of monitoring data, Resistomap seeks to enhance the effectiveness of stakeholder actions against AMR, with the ultimate goal of safeguarding millions of human and animal lives.

Over the next three years, our main hurdle is securing the financial backing necessary to sustain and advance our services. Developing our Intelligence Platform demands substantial investment in human resources, spanning laboratory services, software engineering, and business research. A significant part of this challenge is the current market's regulatory inertia, compelling us to rely heavily on endowment funds for ongoing research and development efforts.

This regulatory inertia extends beyond our commercial scope, hindering our ability to gather data internationally, particularly in LMICs. The absence of clear regulatory frameworks in these regions not only impedes our data collection efforts but also our research progress, critical to the Intelligence Platform's development. There is currently no reliable mechanism to define or quantify the risk associated with specific AMR levels in samples and their subsequent social repercussions, further exacerbating this issue.

Despite these formidable challenges, we remain optimistic. We are convinced that, by strategically deploying our solution and engaging with the right experts, we can catalyse the research necessary to foster the development of regulatory frameworks globally. Our goal is not just to navigate through these complexities, but also to push regulatory momentum in AMR management and mitigation in time.

We believe our solution could address the challenges outlined in this Trinity Challenge call, a sentiment echoed by our partners who encouraged our application to this initiative.

Moreover, upon reviewing the challenges, we recognise that we are striving to tackle similar questions. Our primary limitation lies in securing funding to test our technology in real-world environments and assess its proof of value. Therefore, this call presents an ideal opportunity for us to demonstrate and promote engagement among all AMR stakeholders across human, animal, and environmental settings, working together to mitigate the spread of AMR.

With over five years of experience in this field, we are confident that upon the successful completion of the pilot project in Mexico and Colombia, we can scale up this technology globally. Additionally, we anticipate significant cost reductions following the evaluation of the pilot project.

Contact in Mexico:

Dr. Cuauhtémoc Licona-Cassani 

Director of the FEMSA Biotechnology Center at Tecnológico de Monterrey Head of the Industrial Genomics Laboratory

Tecnológico de Monterrey

Contact in Colombia:

Jimmy Everth Becerra Enriquez, PhD

Senior Researcher

Engaged in research projects analysing complex microbiomes, including the human gastrointestinal microbiome, and assessing water quality.

Metropolitana University of Colombia

Other partners:

Antibiotic compound analysis:

Prof Alistair Boxall, University of York, the UK 

Global expert on antibiotic pollution in aquatic environments

https://www.york.ac.uk/environment/our-staff/alistair-boxall/

Data analysis, with a focus on deriving actionable insights for decision-makers:

Jasmine Grimsley, London Data Company, the UK 

Francesca Chiara, CIDRAP, USA 

https://www.cidrap.umn.edu/abo...

Scientific Advisor, providing guidance on the prudent utilisation and interpretation of environmental AMR data:

Prof James Tiedje, Michigan State of University