The One Health concept recognizes the interdependence between humans, animals, and the environment, emphasizing that issues related to public health, animal health, and environmental health must be addressed through an integrated and holistic approach. Understanding the interactions among these domains—and how they influence the emergence and spread of infectious agents and antimicrobial resistance (AMR)—requires strong interdisciplinary and cross-sectoral collaboration. Within CORNELIA, we have assembled researchers representing all three One Health sectors and established collaboration between groups traditionally working from either a biological or technological standpoint.
Antimicrobial resistance (AMR) is among the most pressing health threats of our time and poses a critical challenge to both human and veterinary medicine. The use of antimicrobial agents remains the primary driver of resistance development and dissemination. Genes conferring identical resistance traits have frequently been identified in bacteria isolated from humans, animals, and environmental sources. The CORNELIA project is based on the premise that wastewater, sludge, and manure represent convergence points—or “melting pots”—for bacteria originating from humans, animals, and the environment. Such interfaces create conditions conducive to the emergence of new resistant variants. Bacteria and resistance genes can spread from wastewater and sludge to soil and water systems and eventually re-enter the food chain.
In CORNELIA, we conducted six sampling campaigns over one year, collecting untreated and treated wastewater samples from the VEAS treatment plant. Samples were analyzed using multiple methodologies to assess: the presence of viable bacteria carrying clinically relevant resistance genes, the overall abundance of resistance genes, and the composition of the bacterial community through advanced genetic analyses. Results show that untreated wastewater contains a rich and diverse bacterial community derived from both human and environmental sources, with a wide variety of antibiotic resistance genes—including several novel and previously undescribed resistance types. In contrast, treated wastewater shows a marked reduction in total bacterial abundance, with the remaining microbial community dominated by environmentally associated species. The treatment process had variable effects on resistance gene prevalence: some resistance types were reduced or eliminated, while others became more dominant. Parallel analyses were performed on soil samples fertilized with manure (from animals with and without antibiotic exposure) and sludge from the treatment plant. These soils were stored outdoors for up to two years to assess long-term persistence and transformation of resistance genes.
A key objective of CORNELIA is to develop strategies that can inform a potential national monitoring program for AMR in the environment, complementing existing surveillance frameworks for humans, animals, and food. Through comparative testing of various analytical methods, we have gained valuable insight into their respective strengths and limitations for detecting resistant bacteria and resistance genes. Our findings indicate that the choice of methodology should be guided by the specific objectives of future monitoring and control systems. According to the EU’s new Urban Wastewater Treatment Directive, regular monitoring of AMR in both treated and untreated wastewater will become mandatory for large treatment plants. However, Norway’s approach to implementing this directive remains under consideration.
Two partner companies have contributed with innovative technologies aimed at reducing bacterial loads in wastewater. Hospital effluents are expected to contain particularly high concentrations of resistant bacteria and resistance genes. Pre-treatment of such wastewater prior to discharge into municipal systems offers a promising mitigation strategy. Experimental studies conducted at VEAS and Oslo University Hospital demonstrated a proof of principle for the use of ozone and UV treatment as effective methods for reducing bacterial content and resistance gene prevalence. Nonetheless, further validation studies are required before full-scale implementation.
The CORNELIA project represents a broad collaboration among: NMBU, UiT, FHI, NIBIO, NIVA, OUS, VEAS, Blueshift, and Sustaintech.
Det har gjennom prosjektperioden blitt holdt en rekke faglige foredrag og presentasjoner ved ulike konferanser og arrangementer nasjonalt og internasjonalt. Vi har gjennom ulike metodologiske tilnærminger til analyse av urenset og renset avløpsvann fått fram fordeler og ulemper ved bruk av de ulike metodene. Dette betyr at det er bygget opp en solid kunnskapsbase som vil være av betydning for den framtidige implementeringen av det reviderte Urban Wastewater Treatment-direktivet i Norge, samt en eventuell utvidelse av eksiterende overvåkningsprogram av antibiotikaresistens til også å omfatte miljø. En slik utvidelse av overvåkningsprogrammet er tidligere diskutert av Vitenskapskomiteen for mat og miljø, som i sin utredning nettopp henviste til et behov for mer kunnskap om bruk av ulike metoder. Metagenomiske analyser, inkludert ekstra sensitive metoder, gir en god oversikt over resistensgener og deres bakterielle verter som har sentral klinisk relevans og betydning, men de kan også brukes til å studere naturlig forekommende resistensfenomener og hittil ukjente resistensegenskaper. Samtidig har vi også vist hvordan helgenomsekvensering av bakterielle isolater som Escherichia coli gir mulighet for svært detaljerte analyser av resistensgener overfor kritisk viktige antibiotika, samt virulensgener. Slike detaljstudier viser seg å være å komplementere metagenomstudier for å vurdere spredning av antibiotikaresistente bakterier som kan representere en folkehelserisiko, og bør derfor inngå som et ledd i overvåkning av resistens.
Videre har en pilotstudie av potensiale for utvikling og spredning av resistensgener i jord bidratt til utbedring og raffinering av en chip-basert hurtigmetode for påvisning av et utvalg resistensgener. Studien demonstrerer en høy diversitet og persistens av resistensgener i jord. Den har gitt grunnlag for et mer omfattende forskningsprosjekt med internasjonale partnere som vil gi et enda bedre grunnlag for å vurdere både folkehelserisiko ved bruk av husdyrgjødsel og slam som jordforbedring og vurdering av tiltak som kan begrense spredning av resistens.
Prosjektet hadde som ytterligere mål å utvikle og demonstrere systemer for målrettet behandling av avløpsvann både ved kilden og nedstrøms for å redusere forekomsten av resistente bakterier og resistensgener. Gjennom å teste slike systemer på både renset avløpsvann og urenset kloakkvann fra et sykehus er prinsippet om ozon- og UV-behandling etablert. Mer omfattende forsøksserier, detaljerte genetiske analyser og vurdering av gjenvekstdynamikk er imidlertid nødvendig for å forbedre og skalere driftsstrategier og evaluere langsiktige miljøeffekter.
Et mål med prosjektet var å utforske fordelene ved å arbeide i en Én helse-atmosfære. Prosjektdeltakere tilhørte i utgangspunktet akademiske miljøer fra humanmedisin, veterinærmedisin, naturvitenskap og teknologi, to innovasjonsselskaper, et renseanlegg og et sykehus. Vi mener det har vært et tett og inspirerende samarbeid.
The One Health perspective is based on an understanding that human, animal and ecosystem health are inextricably linked. As antimicrobial resistance (AMR) exists in and affects all sectors, a One Health approach is required to address the dynamic and cross-sectorial behavior of the current AMR-threat. Environmental compartments as water and soil are dynamic and complex compartments representing important interfaces for all One Health sectors but are yet the most neglected part of One Health-AMR initiatives. The CORNELIA project (Antimicrobial Resistance in One Health Interfaces) challenges the environmental knowledge gap, and addresses development and dissemination of AMR in soil and aquatic environments as they are important interfaces between humans and animals. We do this with an interdisciplinary and cross-sectorial approach, involving participation from all the three pillars of One Health and bringing the biology and technology sectors together in exploiting new technologies for data analysis and surveillance, development of diagnostic tools and establishment of mitigation measures.
CORNELIA is organized into five scientific workpackages, and each workpackage is designed to fill in knowledge gaps described in previous research and risk assessments: 1) Occurrence of AMR in environmental interfaces, 2) New diagnostic tools and new technologies for diagnosis and metagenome and whole genome sequence data, 3) Persistence, transmission and expression of AMR in environmental interfaces, 4) Strategies for surveillance of AMR in the environment, 5) Innovative technologies for AMR mitigation and wastewater treatment.
The comprehensive CORNELIA team consists of scientific partners from NMBU, FHI, UiT, NIBIO, and NIVA, and two start-up companies within wastewater technology; Blueshift AS and Sustaintech AS. Access to relevant sampling and testing of technology are ensured through collaboration with OUS and VEAS.
