Abstract
BackgroundAntimicrobial resistance (AMR) is a global public health concern that requires transdisciplinary and bio-social approaches. Despite the continuous calls for a transdisciplinary understanding of this problem, there is still a lack of such studies. While microbiology generates knowledge about the biomedical nature of bacteria, social science explores various social practices related to the acquisition and spread of these bacteria. However, the two fields remain disconnected in both methodological and conceptual levels. Focusing on the acquisition of multidrug resistance genes, encoding extended-spectrum betalactamases (CTX-M) and carbapenemases (NDM-1) among a travelling population of health students, this article proposes a methodology of ‘stool and stories’ that combines methods of microbiology and sociology, thus proposing a way forward to a collaborative understanding of AMR.MethodsA longitudinal study with 64 health students travelling to India was conducted in 2017. The study included multiple-choice questionnaires (n = 64); a collection of faecal swabs before travel (T0, n = 45), in the first week in India (T1, n = 44), the second week in India (T2, n = 41); and semi-structured interviews (n = 11). Stool samples were analysed by a targeted metagenomic approach. Data from semi-structured interviews were analysed using the method of thematic analysis.ResultsThe incidence of ESBL- and carbapenemase resistance genes significantly increased during travel indicating it as a potential risk; for CTX-M from 11% before travel to 78% during travel and for NDM-1 from 2% before travel to 11% during travel. The data from semi-structured interviews showed that participants considered AMR mainly in relation to individual antibiotic use or its presence in a clinical environment but not to travelling.ConclusionThe microbiological analysis confirmed previous research showing that international human mobility is a risk factor for AMR acquisition. However, sociological methods demonstrated that travellers understand AMR primarily as a clinical problem and do not connect it to travelling. These findings indicate an important gap in understanding AMR as a bio-social problem raising a question about the potential effectiveness of biologically driven AMR stewardship programs among travellers. Further development of the ‘stool and stories’ approach is important for a transdisciplinary basis of AMR stewardship.
Highlights
Antimicrobial resistance (AMR) is a global public health concern that requires transdisciplinary and bio-social approaches
To present the methodology of stool and stories, in this article we focus on the acquisition of multidrug resistance genes encoding the extended-spectrum beta-lactamase (ESBL) enzymes of the CTX-M group and the NDM-1 carbapenemases among a population of health students who travelled to India from different parts of the world
Positioning stool and stories into a transdisciplinary dialogue challenges the current policy assumptions about AMR being primarily a problem of antibiotic consumption or a lack of antibiotic awareness. It may suggest a need for re-conceptualisation of AMR as a problem of environmental concern, broadening its current narrow focus on antibiotics and looking at various interactions between microorganisms, travellers, as well as local environments
Summary
Antimicrobial resistance (AMR) is a global public health concern that requires transdisciplinary and bio-social approaches. A policy brief from 2019 by the WHO emphasized the importance of cultural contexts for understanding and developing solutions for AMR [9] Despite these calls, there has been a lack of studies that engage with both the biological and social nature of AMR simultaneously limiting the opportunities to address this problem from a transdisciplinary angle. There has been a lack of studies that engage with both the biological and social nature of AMR simultaneously limiting the opportunities to address this problem from a transdisciplinary angle To this end, in this article we explore a conceptual idea and present the results of transdisciplinary research that combines methods and concepts of microbiology and sociology, we called this methodology ‘stool and stories’. We argue, should become a tool for transdisciplinary collaborations aiming at understanding AMR in its biosocial multiplicity
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
