Grant: Operating Grant: 13th JPIAMR transnational call for research projects

Colistin (polymyxin E) is considered a last resort antimicrobial for treatment of infections with multidrug- resistant bacteria, classified by WHO as 'highest prioritized, critically important for human medicine'. WHO suggests to ban or highly restrict its use in animals. In Indonesia, colistin resistance in human Escherichia coli isolates is poorly characterized as it requires specific non-routine tests. Detection of colistin resistance in E. coli in poultry resulted in a ban for livestock in Indonesia in 2020. However, no information is available on the effectiveness of this ban. Colistin is also suspected to be routinely used in humans in multiple settings but these practices are poorly understood. In this project, we propose to assess the effectiveness of the initial ban on colistin use in livestock in reducing colistin resistance in humans and animals, and further explore how a One Health perspective can strengthen this intervention. This project aims to: i) determine phenotypic and genotypic colistin resistance in E. coli from humans and poultry in Indonesia pre- and post-ban; ii) assess the impact of the colistin ban on resistance in E. coli in animals and humans; iii) estimate the transmission of colistin resistance between animals and humans; iv) study colistin use and their drivers at the community level; and v) expand the initial colistin ban in the animal production sector into an integrative multi-sectorial One Health intervention, which will be designed and implemented using a community-based participatory approach. This project will provide a strong scientific basis to AMR policies in Indonesia, with great significance across Southeast Asia.