BMJ Global Health (Nov 2020)

Whole-genome sequencing as part of national and international surveillance programmes for antimicrobial resistance: a roadmap

  • Iruka N Okeke,
  • Ben Taylor,
  • Celia Carlos,
  • Nicole Wheeler,
  • Marietta Lagrada,
  • Polle K. Macaranas,
  • Agnettah M. Olorosa,
  • June Gayeta,
  • Melissa Ana Masim,
  • Elmer M. Herrera,
  • David M Aanensen,
  • Khalil Abudahab,
  • Monica Abrudan,
  • Silvia Argimon,
  • Harry Harste,
  • Mihir Kekre,
  • Ali Molloy,
  • Dawn Muddyman,
  • Anneke Schmider,
  • Anthony Underwood,
  • María del Pilar Donado Godoy,
  • Johan Fabian Bernal Morales,
  • Alejandra Arevalo,
  • Maria Fernanda Valencia Guerrero,
  • Erik Cristopher Dustin Osma Castro,
  • Anderson O. Oaikhena,
  • Ayorinde Oluwatobiloba Afolayan,
  • Jolaade J Ajiboye,
  • Ravikumar K. L.,
  • Geetha Nagaraj,
  • Varun Shammana,
  • Vandana Govindan,
  • Akshata Prabhu,
  • Darmavaram Sravani,
  • Shincy M. R.,
  • Rajitha G. V.,
  • Carolin Vegvari,
  • John Stelling

DOI
https://doi.org/10.1136/bmjgh-2019-002244
Journal volume & issue
Vol. 5, no. 11

Abstract

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The global spread of antimicrobial resistance (AMR) and lack of novel alternative treatments have been declared a global public health emergency by WHO. The greatest impact of AMR is experienced in resource-poor settings, because of lack of access to alternative antibiotics and because the prevalence of multidrug-resistant bacterial strains may be higher in low-income and middle-income countries (LMICs). Intelligent surveillance of AMR infections is key to informed policy decisions and public health interventions to counter AMR. Molecular surveillance using whole-genome sequencing (WGS) can be a valuable addition to phenotypic surveillance of AMR. WGS provides insights into the genetic basis of resistance mechanisms, as well as pathogen evolution and population dynamics at different spatial and temporal scales. Due to its high cost and complexity, WGS is currently mainly carried out in high-income countries. However, given its potential to inform national and international action plans against AMR, establishing WGS as a surveillance tool in LMICs will be important in order to produce a truly global picture. Here, we describe a roadmap for incorporating WGS into existing AMR surveillance frameworks, including WHO Global Antimicrobial Resistance Surveillance System, informed by our ongoing, practical experiences developing WGS surveillance systems in national reference laboratories in Colombia, India, Nigeria and the Philippines. Challenges and barriers to WGS in LMICs will be discussed together with a roadmap to possible solutions.