Webinar summary:
Getting to know the science behind Resistomap

Resistomap monthly webinar series has returned! The webinars this autumn are centred on the science and application of antibiotic resistance monitoring. The August webinar was the first in this series. We had Resistomap’s Scientific Advisor Prof. James Tiedje and CEO Dr. Windi Muziasari presenting the science behind Resistomap’s antibiotic resistance monitoring service.
‍
As the first speaker of the webinar, Prof. Tiedje provided an update on the science behind antibiotic resistance gene (ARG) testing. He started his presentation by introducing a list of problematic genes and bacteria and the different environmental sources of ARGs. Resistances and organisms in wastewater were suggested to be the most important source from the environmental side, as it goes from sources with high antibiotic use (e.g., hospitals) to wastewater treatment facilities (or lack thereof) to being released to rivers. 
Prof. Tiedje then continued by introducing and comparing the different methods for assessing ARGs. The methods can generally be classified into three groups: culturing, qPCR, and DNA (shotgun) sequencing. Culturing can detect functional resistance and the pathogen, but this method is slow, more costly, and tedious. Meanwhile, qPCR allows for the detection of ARG fragments. Compared to the other methods, high-throughput qPCR is the most sensitive, fast, and easily updated. The final method is through DNA (shotgun) sequencing. DNA sequencing is more costly and is therefore more suitable as a front-edge research tool than for surveillance. 
‍
Towards the end of his presentation, Prof. Tiedje shared an important study that aimed to identify risky and emerging ARGs. By examining the concentration of antibiotics in different environments of human impact, a 4-level ARG risk ranking framework was developed. Interestingly, and also quite worrying, not all ARGs categorized as Rank 1 (highest risk) in the framework were on WHO’s priority pathogen list. Some of these ARGs were also found in hospital plasmids, signifying its emergence and possible spread. This highlights the importance of monitoring ARGs, even beyond the list provided by WHO, and the need to continue updating the methods for ARG surveillance.
Next, our CEO Windi introduced Resistomap by providing an overview of its services, team, and projects. She highlighted that Resistomap’s target market is not only the research sector but also includes hospitals, wastewater management services, and municipalities. One example was the recent project with Helsinki University Hospital (HUS) where the digital platform ResistApp was piloted for routine wastewater-based monitoring of antibiotic resistance in Finnish hospitals.

In the second half of her presentation, Windi provided a step-by-step guide for using Resistomap’s services, starting from sample handling to customizing the SmartChip qPCR measurement. Results of the data analysis are then available on ResistApp, which Windi provided a preview of. She showed the different information that could be viewed on this interactive dashboard, such as the number of detected genes and relative abundance over time. Finally, a video tour was provided by a member of Resistomap’s lab team Alma, where she showed the laboratory and office space where Resistomap is operating.
‍
The last part of the webinar was a roundtable discussion where both speakers addressed questions raised by the audience. There were questions around the qPCR method, mobility of genes, and enrichment of ARGs amongst others. One question that intrigued me was on the concentration limit for ARGs in wastewater before it could be released to the environment. Windi mentioned that there is currently no limit yet but this is something that she has been pushing for. It should be regulated, but a lot of study is still needed on the health impacts of ARGs in the environment. Another question was on where continuous monitoring should be done, considering that everything is interconnected (One Health). According to Prof. Tiedje, as we are now at the beginning stage of a larger problem, the focus should be at sources where the risk is highest based on current knowledge. Wastewater has a lot of potential for this monitoring. In Windi’s opinion it is currently most important to monitor hospitals due to the high antibiotic use including for treating pathogens. It does not matter in which country; all hospitals use antibiotics and it is therefore extremely important to monitor antibiotic resistance in this sector.
‍
In her closing remarks, Windi emphasized the importance of understanding the issue of antibiotic resistance and to spread awareness in one’s network. Antibiotic resistance is a multi-sectoral issue but the problem is unfortunately still not much known outside of academia. As reminded by Prof. Tiedje, resistance genes are just a plane ride away and from Covid we learn how diseases can spread very fast.

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