TEXAS: Towards next-generation AMR surveillance: Assessment of novel technologies with high-throughput and multiplexing potential

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There is growing recognition that reducing global AMR requires integrated surveillance of clinically relevant markers (e.g., genes associated with specific resistant pathogens, "drug-bug" combinations). However, there is no consensus regarding which markers to target and what exposures are safe, or what technologies are most suitable for monitoring the selected markers. The proposed TEXAS project will define a suite of geneticmarkers that best describe AMR status of a targeted location, and integrate them into multiplexed platforms using new technologies that do not require cultivation of bacteria. A digital droplet PCR (ddPCR) platform (suitable for high income regions) will quantify clinically relevant markers in a diverse range of environments, generating large and synchronized datasets that can be exploited for comparative AMR status, facilitatingunderstanding of AMR across different One Health sectors. In tandem, an electrochemical biosensor will provide a means for high-throughput on-site monitoring of selected AMR markers. The biosensor does not require special equipment or trained operators, and thus can be applied in low income regions that lack sophisticated infrastructure. The multidisciplinary TEXAS consortium includes experts in electrical and water engineering, genomic epidemiology, molecular microbial ecology, public health, and policy guidance. Consequently, we are confident that the project will generate implementable technological solutions that can be adopted by stakeholders for integrated surveillance that will be fundamental to reducing global AMR.