Extended Spectrum Beta-lactamase-producing Surveillance in the Human, Food Chain, and Environment Sectors: Tricycle Project (pilot) in Indonesia

The World Health Organization (WHO) has been implementing antimicrobial surveillance with a "One Health" approach, known as the Global Surveillance ESBL Tricycle Project. We describe the implementation of the Tricycle Project (pilot) in Indonesia, focusing on its results, challenges and recommendations. The samples were 116 patients with bloodstream infections caused by ESBL , 100 rectal swabs collected from pregnant women, 240 cecums of broiler, and 119 environmental samples, using the standardized method according to the guidelines. ESBL-producing was found in 40 (40%) of the 100 pregnant women, while the proportion of ESBL-producing was 57.7% among the total -induced bloodstream infections. ESBL-producing was isolated from 161 (67.1%) out of 240 broilers. On the other hand, the average concentration of in the water samples was 2.0 × 10 CFU/100 mL, and the ratio of ESBL-producing was 12.8% of total . Unfortunately, 56.7% of questionnaires for patients were incomplete. The Tricycle Project (pilot) identified that the proportion of ESBL-producing was very high in all types of samples, and several challenges and obstacles were encountered during the implementation of the study in Indonesia. The finding of this study have implication to health/the antimicrobial resistance (AMR) surveillance. We recommend continuing this project and extending this study to other provinces to determine the AMR burden as the baseline in planning AMR control strategies in Indonesia. We also recommend improving the protocol of this study to minimize obstacles in the field.