Global Surveillance of Antimicrobial Resistance

The Global Surveillance of Antimicrobial Resistance is a center funded by the Novo Nordisk Foundation Challenge Programme. The center is funded with 60 million DKK from 2017 – 2023.

Antimicrobial resistance (AMR) is a cross-cutting and increasing threat to global health. Accurately describing and characterizing the global burden and transmission of AMR is essential to address this challenge and support national and global priority setting, public health actions, and treatment decisions.

The multidisciplinary Center will work from the hypothesis that metagenomic sequencing of human sewage can be used to detect, and in combination with epidemiological / ecological modeling, explain and predict emergence and trends of AMR. Sewage will be sampled from +100 cities around the world. Initially, the aim will be to explain variation associated with sampling, DNA-extractions/sequencing, bioinformatics analysis, and selected explanatory variables. Sharing most of the data in real-time is expected to engage the global research community, providing novel input and additional data. The discovery phase will identify novel procedures for sampling and laboratory analysis, bioinformatics methods and modeling. From this, it is the intention to optimize sampling design for global AMR surveillance, and develop mathematical models to explain the current occurrence and predict future emergence and spread of AMR.

Addressing these AMR research questions requires an interdisciplinary effort. The proposed Center is in an excellent position to successfully complete this as there are already well-established local and global networks, as well as proven expertise, knowledge and contacts for the key steps. It has also been confirmed that this approach has limited ethical issues because sampling is not conducted on an individual basis, facilitating real-time sharing of the data worldwide.

It is expected that this Center will initiate the first global real-time, large-scale AMR surveillance of human populations, facilitating better and faster detection of AMR leading to a paradigm shift in the way AMR surveillance is conducted and the real-time results are shared and analyzed.

Key research questions are:

  • Can sequencing and quantification of all AMR genes in sewage reliably determine AMR occurrence and changes in populations and thereby be used for global surveillance?
  • What is the importance of correlating AMR genes to bacterial species?
  • Can novel ecological methods provide more reliable comparisons across locations and over time?
  • Which epidemiological data can best explain the occurrence of AMR at national and global level?
  • What are the most likely connectivity and transmission routes around the world?
  • Can the developed models predict future emergence and spread of AMR?
  • How can the results be presented and shared Will sharing of data in real-time engage the global research community, providing better and faster results and will this in return enable the project participants to perform better?

The Center currently has the following PhD/postdoc projects:


  • Importance of mobile elements for global transmission of antimicrobial resistance
  • Machine learning of antimicrobial resistance
  • Humane microbiome interaction


  • Epidemiology of global drivers

Frank Møller Aaresstrup
Co-Coordinator of VEO
DTU National Food Institute

Mark Woolhouse
The University of Edinburgh