A battle against antibiotic resistance

As an epidemiology postdoc at the Pasteur Institute in Paris, Maya Nadimpalli became interested in antibiotic resistance among young children in low-income countries. Now at Tufts University near Boston, Massachusetts, Nadimpalli shares the opportunities and challenges of studying public health in developing nations.

Describe your research approach.

My PhD focused on disentangling how large-scale agriculture and antibiotic use could contribute to the evolution and dissemination of antibiotic resistance in humans. When I started my postdoctoral research in 2015, there was a sense, based on limited evidence from research done in the United States and Europe, that antibiotic use in animals wouldn’t affect human populations. But no one had really studied what was happening in low-income, yet rapidly developing, countries — especially those where both meat consumption and antibiotic use are increasing dramatically, such as Cambodia.

How did you come to do research in Cambodia?

While at the Pasteur Institute, I worked on the Bacterial Infections and Antibiotic Resistant Diseases Among Young Children in Low-Income Countries project in Cambodia, Madagascar and Senegal. We wanted to determine whether women were colonized with drug-resistant bacteria, because they could be transmitting them to children. In Paris in 2013, 6% of healthy people are colonized with these β-lactamase-producing strains — they are asymptomatic, but have the bacteria in their gut. In southeast Asia, however, colonization is much higher, more than 60%. And, in Cambodia, there is poor control of widely available antibiotics, raw meat in markets is often handled by hand and consumption of meat dried in the sun with salt and lime is common. My research showed that dried-meat consumption is a risk factor for acquisition of these drug-resistant bacteria.

Collection: Fieldwork

Describe the logistics of this kind of research.

It can be overwhelming to plan fieldwork across countries and time zones, not to mention secure ethics approvals and shipping permits and work out lab protocols that can be accomplished with limited resources. For example, it’s tricky to publish data on antibiotic resistance in animals, so we sampled food. We spent months developing the protocols in France and obtaining all the supplies we’d need for fieldwork. In some countries, it can take three months to receive a reagent or an extraction kit.

How has this experience shaped your career goals?

I want to continue doing research in developing countries. I’ve joined the new Center for Integrated Management of Antimicrobial Resistance at Tufts University. It’s one of the few places in the United States that is prepared to answer questions from a ‘one health’ perspective — a transdisciplinary concept that recognizes that the health of people is connected to the health of the environment and of animals — because it has a school of medicine, a school of engineering and a veterinary school. The centre also builds on the work and legacy of Stuart Levy, the now-retired physician and director of the Tufts Center for Adaptation Genetics and Drug Resistance at the Tufts School of Medicine, who has warned for decades of the impacts of antibiotic resistance. My next step is to apply for grants to conduct follow-up work in Cambodia, as well as in middle-income countries such as India, where industrial agriculture is growing quickly. I’m interested in how young children are becoming exposed to antibiotic resistance so soon, especially in areas where dietary practices are changing at the same time. For example, some women are breastfeeding less and relying more on formula milk.

What’s your advice for those doing research abroad?

Learn as much as you can about the work culture and scientific institutions in the country you plan to go to — for example, how they decide which research questions are worth investigating, how open they are to interdisciplinary research and how you can establish collaborations. When I first arrived in France, the Pasteur Institute staff held a workshop on research culture for international students. France, for example, has a more formal hierarchy than does the United States. Pasteur staff members made it clear that new ideas are met with greater scepticism than in the United States, and require a fully challenged argument before they are accepted. It was extremely helpful to readjust my approach and expectations to work effectively there.