Environmental Surveillance of Antimicrobial Resistance (2026-2027)

Please note that this is a joint Duke-DKU team that will include faculty and students from both institutions. Applicants should be excited to work collaboratively across institutions and should expect to coordinate meetings across time zones.

Background

Antimicrobial resistance (AMR) is one of the most urgent global health threats, projected to contribute to 10 million deaths per year by 2050. AMR occurs when bacteria, viruses, fungi or parasites develop resistance to the drugs designed to treat them. Excessive antibiotic use in agriculture and animal husbandry, inadequate regulation of pharmaceutical waste and the availability of over-the-counter antimicrobials in many low- and middle-income countries (LMICs) accelerate the spread of resistant organisms.

Climate change also amplifies AMR. Rising temperatures increase mutation rates, while extreme weather events — such as flooding — spread contaminated water, waste and resistant pathogens into surrounding environments. In LMICs, where water, sanitation and hygiene infrastructure is often under-resourced, AMR can disseminate quickly through wastewater and natural water bodies.

Although global policy documents strongly advocate for environmental AMR monitoring, most surveillance systems today focus on clinical samples rather than environmental sources. This project responds to that gap by designing an evidence-based, adaptable model for LMICs to detect antimicrobial-resistant organisms, resistance genes and antimicrobial residues in water and wastewater.

Project Description

This project will take a mixed-methods, One Health-oriented approach to create a blueprint for LMICs to implement wastewater-based AMR surveillance. Given the locations of the team’s faculty leaders, the initial model will focus on China and Sri Lanka, with broader applicability for similar settings.

The work unfolds across three phases:

Evidence synthesis
The team will systematically review scientific publications, grey literature and expert recommendations to identify:

High-risk environmental contamination sources (e.g., hospitals, farms, manufacturing, laboratories)
Water dynamics that influence AMR spread, especially during flooding
Existing environmental AMR surveillance efforts and methodological gaps

Evidence will be stored and analyzed using a predefined framework that enables pattern recognition and cross-country comparison.

Model development
Based on the synthesized evidence, the team will develop a surveillance blueprint for wastewater and water bodies, outlining:

Priority sampling sites
Minimum monitoring frequency and surge protocols during high-risk events
Laboratory and data management specifications
Action plans for responding to surveillance findings

The team will also conduct a policy analysis to assess the strengths and weaknesses of relevant national and international policies, generating recommendations for stronger governance and improved mechanisms for data sharing.

Policy recommendations and stakeholder strategy
The team will draft guidance for policymakers on how to implement wastewater AMR surveillance within real monetary, legal and practical constraints. This phase includes preparing a dissemination and advocacy plan to support uptake among government stakeholders, public health agencies and environmental regulators.

Anticipated Outputs

Evidence-based surveillance blueprint for AMR monitoring in wastewater and water bodies
Policy recommendations report
Scientific research article
Bass Connections research poster
Presentation at an international conference

Student Opportunities

The team will include 2-4 graduate or professional students and 5-6 undergraduate students across Duke, Duke Kunshan University and the Duke-Ruhuna Collaborative Research Centre.

Students from medical sciences, infectious diseases, global health, biology, microbiology, molecular biology, biomedical engineering, environmental science, public policy and political science are encouraged to apply.

Students will gain experience in:

Conducting systematic reviews
Designing mixed-methods research
Analyzing AMR evidence and water surveillance models
Applying One Health frameworks
Conducting policy analysis and drafting recommendations
Working across global teams in China, Sri Lanka and the United States
Producing communication materials, including posters, manuscripts and webinars

Graduate students and the team’s project manager (research scientist in Sri Lanka) will mentor undergraduates and coordinate cross-country collaboration.

In Fall 2026, this team will meet on Wednesdays from 8:30-9:45 a.m. EST via Zoom, to facilitate international partnership across countries. All team members are expected to participate in these weekly meetings.

Timing

Fall 2026 – Summer 2027

Summer 2026 (optional):

Conduct literature review

Fall 2026:

Conduct evidence review and synthesis
Analyze related policies

Spring 2027:

Develop the surveillance blueprint
Draft policy recommendations

Summer 2027 (optional):

Students may work refine outputs and assist with dissemination

Crediting

Academic credit available for fall and spring semesters