02387nas a2200253 4500000000100000008004100001260001200042653000800054653000900062653002100071653001100092653001500103653002500118100001600143700001300159700001600172700001400188245011800202856007900320300001200399490000800411520170000419022001402119 2024 d c08/202410aAMR10aESBL10aEnterobacterales10aMalawi10afreshwater10asnail-borne diseases1 aO'Ferrall A1 aMusaya J1 aStothard RJ1 aRoberts A00aAligning antimicrobial resistance surveillance with schistosomiasis research: an interlinked One Health approach. uhttps://academic.oup.com/trstmh/article-pdf/118/8/498/58736668/trae035.pdf a498-5040 v1183 a

One Health surveillance involves the analysis of human, animal and environmental samples, recognising their interconnectedness in health systems. Such considerations are crucial to investigate the transmission of many pathogens, including drug-resistant bacteria and parasites. The highest rates of antimicrobial resistance (AMR)-associated deaths are observed in sub-Saharan Africa, where concurrently the waterborne parasitic disease schistosomiasis can be highly endemic in both humans and animals. Although there is growing acknowledgment of significant interactions between bacteria and parasites, knowledge of relationships between schistosomes, microbes and AMR remains inadequate. In addition, newly emergent research has revealed the previously underappreciated roles of animals and the environment in both AMR and schistosomiasis transmission. We consider shared environmental drivers and colonisation linkage in this narrative review, with a focus on extended-spectrum beta-lactamase-mediated resistance among bacteria from the Enterobacteriaceae family, which is exceedingly prevalent and responsible for a high burden of AMR-associated deaths. Then we examine novel findings from Malawi, where the landscapes of AMR and schistosomiasis are rapidly evolving, and make comparisons to other geographic areas with similar co-infection epidemiology. We identify several knowledge gaps that could be addressed in future research, including the need to characterise the impact of intestinal schistosomiasis and freshwater contact on intestinal AMR colonisation, before proposing a rationale for connecting AMR surveillance and schistosomiasis research within a One Health framework.

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