Drivers_of_antimicrobial_resistance_in_Uganda_and_Malawi_DRUM_. Drivers_of_antimicrobial_resistance_in_Uganda_and_Malawi_DRUM_

The mechanisms that support the emergence, movement, and persistence of antimicrobials within communities are poorly understood both qualitatively and quantitatively. This makes it difficult to identify or predict the impact of intervention strategies. DRUM will characterise the emergence and spread of AMR within complex social settings in Malawi and Uganda using an agent-based modelling approach informed by DNA sqeuence data. Specifically, for this partcular part of the study we will answer the following three questions: What is the overall diversity in ESBL-E and ESBL-K across the different sample sources? How does the ESBL-E/ESBL-K diversity link to units of AMR transmission? Methods: Human and animal stool and environmental samples have been longitudinally collected from 400 households in urban, peri-urban and rural settings in Malawi and Uganda. We will sequence mixtures of colonies harvested from an enrichment culture by sweeping whole plates of randomly selected samples. Expected findings The study will help to quantify within and between samples diversity and transmission bottle necks. These findings will inform an agent based model, which will be devloped to model transmission dynamics of ESBL producing E. Coli and K. pnuemoniae in Uganda and Malawi communities.