Title: Airborne antimicrobial resistance: identifying the main environmental sources and health impacts
Funder: The Academy of Medical Sciences

Abstract: Aims: Identify the main environmental sources of airborne antimicrobial resistant (AMR) microorganisms and the health risk from the airborne resistome. Objective 1: Characterise the airborne resistome at sources identified as reservoirs of antimicrobial resistance genes (ARGs) and evaluate their contribution to AMR dispersal. Objective 2: Evaluate the health risks from airborne AMR, including if/which AMR infections are acquired in community or healthcare. Objective 3: Develop a toolkit for rapid detection of key ARGs. Objective 4: Translate my research into public health benefits. The widespread availability of antimicrobial drugs has led to vast gains in life expectancy. But the emergence of AMR threatens to rollback these gains. Understanding the role the environment plays in the spread of ARGs is critical in preventing infection and improving antimicrobial stewardship. High-throughput-sequencing has revolutionised our understanding of microbial ecology, showing that ARGs are ubiquitous in soil and water. The technical challenge of applying these methods to air samples leaves our understating of the airborne resistome lagging. We don't know if the air is a significant route for AMR dispersal or a risk to human health. I recently published the first comprehensive molecular ecology air sampling guide. Using my optimised methods, I will conduct the first comprehensive description of the airborne resistome. I will determine which ARGs spread through the air, which emitters are most important, and evaluate health risks. Providing an evidence base and novel tools to integrate the airborne resistome into clinical practice, meeting the Academy’s vision of improving health through research.

Lay abstract: Antimicrobial drugs (e.g. antibiotics) are the cornerstone of modern medicine. Their widespread availability has led to vast gains in life expectancy. But the emergence of antimicrobial resistance (AMR) threatens to rollback these gains. Without antibiotics, key medical procedures, from caesarean sections to chemotherapy, could become too risky to perform. By 2050 it is predicted that more people will die of AMR infections than cancer. Therefore, AMR is a critical threat to global health and an urgent research priority. The environment is the largest source of AMR microorganisms. Understanding the role of the environment in the spread of AMR is essential. Despite good evidence that the air harbours AMR, most research have focused on water and soil. We are therefore missing a fundamental piece of the jigsaw, undermining our ability to respond to the AMR threat. The primary reason for our lack of understanding is the difficulty in applying modern methods to air samples. I have developed novel, reliable methods to overcome this problem, which have been proven in the detection of airborne AMR. I will apply my novel methods to determine what the most important sources of airborne AMR are, focusing on how and where vulnerable people are exposed to AMR pathogens. I will develop new tools to support prevention and treatment of AMR infections. This project will provide foundational knowledge and raise awareness of airborne AMR, which will be invaluable in the fight against AMR.

Research activity codes: 2.1 BIOLOGICAL AND ENDOGENOUS FACTORS;2.2 FACTORS RELATING TO PHYSICAL ENVIRONMENT
Health categories: INFECTION