Monitoring ARGs in Nepal:
Commendable antimicrobial resistance (AMR) research in Nepal, yet fight against AMR still continues.

As part of the monthly webinar series: Monitoring antibiotic resistance genes (ARGs) in low-and middle-income countries (LMICs), the May webinar focused on AMR (antimicrobial resistance) research in Nepal. Two dynamic invited-speakers Dr. Dibesh Karmacharya (Chairman/Executive Director of Center for Molecular Dynamics – Nepal (CMDN)) and Adarsh Man Sherchan (conservation geneticist and founder of Bagmati Biome Project) gave insights to their ongoing and prospective AMR research in Nepal. Panel discussion followed the presentations where speakers answered questions from the audience, and the webinar ended with closing remarks from the speakers. Jesse Majlander (operation manager at Resistomap) hosted the session.
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Dr. Karmacharya was the first speaker of the webinar. He gave an overview of AMR and antibiotic resistance research conducted by CMDN in Nepal, and briefed about their One-health approach on environmental, animal and clinical aspects of AMR research in Nepal. Dr. Karmacharya presented data on a case study related to environmental surveillance of Salmonella Typhi in sewage samples. He discussed about the multi-disciplinary approach they implemented in the study which included microbiology techniques for bacteria culture, molecular and insilico techniques such as PCR, Sanger sequencing, whole genome sequencing (WGS) and sequence alignment for characterization of microbial species, GIS mapping of the sewage lines for the field surveillance, and mathematical modelling for predicting incidence of typhoid in the population. Further, using metagenomics, metabolomics and WGS, they were able to detect and characterize other pathogens (bacteria and virus prevalent in clinical samples) in the sewage samples. Overall, the case study showed Salmonella Typhi infection (cases of typhoid) decreased in the areas where people were administered typhoid vaccine. Further, with the use of a holistic approach, CMDN team was able to get a broad ecological snapshot of microbiota in the sewage samples. In the second part of the presentation, Dr. Karmacharya talked about One Health case study focusing on prevalence/sharing of ARGs among animals, humans and the environment in Kathmandu (capital of Nepal). They used a qPCR based approach for AMR detection. Apparently, ducks had the most AMR genes among the species analyzed which included ducks, chicken, swine and cattle to name few. Streptomycin resistance was most present among the tested samples. AMR genes were also detected in human stool samples, and in two big river systems passing through the Kathmandu valley.

Adarsh was the second speaker of the day. His presentation focused on the environmental aspect of AMR, specifically in a river system (Bagmati) flowing through the Kathmandu valley. His vision is to make Bagmati river cleaner and AMR-free, and to restore Bagmati to its natural form as it was a few decades ago. With this vision, Adarsh has initiated the Bagmati biome project. Adarsh introduced and gave an overview of the Bagmati biome project. He discussed the impact of Bagmati biome project on the socio-economic dynamics, diseases and public health, biodiversity, and one health and one water research. Adarsh talked about how the urban pressure (sewage waste, chemical waste, biochemical waste and low tree plantation) has seriously affected the Bagmati river. Especially due to low numbers of tree plantations in the Kathmandu valley, Bagmati river is unable to replenish itself as the available nature recharge system is inadequate. In addition, Adarsh discussed the importance of wastewater treatment plants in reducing AMR in water systems. Adarsh emphasized on the need for commitment from researchers, public, policy makers, and funding agencies for sustainability of long-term vision projects like Bagmati biome project. 

Last session of the webinar was a panel discussion. In the panel discussion speakers answered questions asked by the audience. The speakers discussed various approaches for molecular subtyping of antibiotic resistance/pathogens in LMICs. Consensus was that the approach must be a combination of techniques that are generic (broader and holistic) enough to detect novel pathogens, along with specific detection techniques for pathogens with prior knowledge. Another question raised in the panel discussion was how (if any) are the governmental policies for controlling use of antibiotics in animal husbandry and in hospitals in Nepal. The speakers mentioned that while there are national-level guidelines for antibiotic use in Nepal, implementation is not as stringent. They also mentioned illegal import of antibiotics for animal husbandry from India (due to open border) and lack of awareness of antibiotic use at the community level as a few reasons for haphazard use of antibiotics in animal husbandry. In addition, for human use, antibiotics can be easily bought in pharmacies, and are not properly prescribed. Given the lack of community level awareness of the use of antibiotics, both speakers highlighted the important role of researchers in advocating controlled use of antibiotics in Nepal, raising awareness in communities, and utilizing evidence-based approaches for the amendment and implementation of national-level guidelines of antibiotic use in Nepal.

Overall, my personal synopsis from the webinar series up until now is that AMR and antibiotic resistance-related issues seem to be quite similar in the LMICs, both in national policies and implementation level. It is important to learn how each LMIC is tackling their AMR issue, and it is equally important to implement the acquired knowledge to their own countries if not implemented yet. LMICs can improve their fight against AMR and antibiotic resistance by information sharing and by collaborations. Platforms such as this webinar series and One Health are crucial.

If you would like to review the webinar discussed here for yourself, a recording is available here