ESBL E.Coli ‘ Tricycle’ project in Indonesia

The Global Integrated Survey on ESBL producing E.coli, or the Tricycle Project, started in November 2018 with the aim to strengthen the antimicrobial resistance (AMR) surveillance system globally/in Indonesia and promote integrated surveillance across human, animal and environment sectors using the One Health approach.

The Indonesian National Institute of Health Research and Development (NIHRD) within the Ministry of Health (MoH) leads this project in collaboration with the Ministry of Agriculture (Balai Veteriner, Subang) and the Ministry of Environment and Forestry (Puslitbang Kualitas dan Laboratorium Lingkungan, Serpong), with additional support from WHO Indonesia.

The ESBL-Ec Tricycle AMR Surveillance project is an international imitative involving Indonesia, Pakistan, Ghana, Madagascar and Malaysia. Additional countries Jordan, Morocco, Sudan, Egypt, Iran, Zimbabwe and Zambia are soon to join the collaboration. The core of the project focuses on the development of a global protocol which is essential for implementing a simplified, integrated and multi-sectoral surveillance system for bacterial resistance to antibiotics in humans, the food chain and the environment. The ESBL-Ec Tricycle AMR Surveillance project focuses on a single key indicator: the frequency rates of ESBL-Ec measured yearly under identical and controlled conditions in humans, food chain, and the environment. WHO South-East Asia has further advanced the project through an additional layer of epidemiological data collection and analysis over and above the Tricycle protocol for the same sample types and number, known as Epi X protocol. The resulting country-specific Tricyle-EpiX surveillance project will characterize determinants of emergence, transmission and directionality of ESBL-Ec between three ‘populations’ - humans, animals and the environment.

Dr Benyamin/WHO

In early May, Dr. Manish Kakkar and Dr. David Sutherland from the WHO South-East Asia Regional office and Dr. Ricardo J. Soares Magalhães plus colleagues from the University of Queensland, facilitated a-three-day workshop in Jakarta. The event was attended by a study team from NIHRD, MoH, Ministry of Agriculture and Ministry of Environment and Forestry as well as the Food and Agriculture Organization (FAO) Indonesia.

The workshop was organized to provide technical assistance to the national study team for data analysis of preliminary information collected from the field. The data analysis included visualization and data processing for spatial epidemiology and DNA sequencing analysis.

The surveillance data collected between December 2018 and May 2019 was analyzed and ESBL-Ec transmission hot spots and modifiable risk factors were identified.
Findings and feedback from the initial data analysis was provided to the national study team and to the Director of Center for Research and Development of Biomedical and Basic Health technology, NIHRD. The visiting experts expressed their positive impression on the progress of the implementation of the ESBL-Ec Tricycle AMR Surveillance project in Indonesia and will continue to provide support to the national study team to analyze and interpret the findings from the final collection of samples.

Once more data is available from Indonesia pilot project, and this is supplemented with the data from pilot studies in India and Nepal, WHO will consider developing a smart surveillance software solution that can be rolled out more widely.