Drug Resistance, BacterialWW-CRO-PREDICTNCT07804433
Wastewater Surveillance for Carbapenem-Resistant Organism Outbreak Prediction in a Chinese Tertiary Hospital
An observational study of Drug Resistance, Bacterial and Carbapenems, run by Peking Union Medical College Hospital at 1 site in China.
Trial summary
Carbapenem-resistant organisms (CRO) pose a critical threat to global public health, and hospitals serve as major epicenters for their emergence and spread. Traditional clinical infection surveillance often detects CRO outbreaks only after infections have already occurred, missing the window for early intervention. Read more about this study
- Who is it for?
- Any age
- Conditions the study is for
- Drug Resistance, Bacterial, Carbapenems, Wastewater
- How many people
- 720 participants
- Where
- 1 siteChina
- Study dates
- 1 Sep 2026to 1 Sep 2028
- Phase
- Observational
- Are there results?
- Not yet: the study is under way
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages Any age
- All sexes
- No healthy volunteers
- Child, Adult, Older adult
Study population: Environmental samples: 24-hour composite wastewater samples from 4 designated sewer manholes (Outpatient Building, Internal Medicine Ward, Surgical Ward, Emergency/Fever Clinic) at Peking Union Medical College Hospital. Clinical data: De-identified CRO-positive culture results from patients treated in the above 4 hospital buildings during the study period.
Who may be able to join
- Wastewater samples collected from the four designated sampling sites (Outpatient Building, Internal Medicine Ward, Surgical Ward, and Emergency/Fever Clinic).
- 24-hour composite samples collected using automatic samplers following the flow-proportional mixing protocol.
- Clinical data: Patients with laboratory-confirmed CRO infection (carbapenem-resistant Enterobacterales, Pseudomonas aeruginosa, Acinetobacter baumannii, etc.) from the above 4 hospital buildings during the study period.
- Clinical data de-identified at the time of extraction.
Who cannot join
- Wastewater samples from sites other than the four designated locations.
- Samples contaminated or degraded during collection, transport, or storage.
- Clinical data: CRO-positive results indicating colonization rather than infection.
- Clinical data with incomplete key information (species, specimen source, date of detection, or department/location).
Trial locations and contacts
1 site in 1 country. Contact the study team or a site near you to ask about taking part.
China1 site
Peking Union Medical College Hospital
Beijing, Beijing Municipality, 100730
yuda fei, Dr, +86 18501360830, fei_yuda@163.com
About this study
Official title: Longitudinal Wastewater Monitoring of Antimicrobial Resistance Genes Across Functional Hospital Areas and Its Association With Clinical Carbapenem-Resistant Organism Infections: A Prospective Observational Cohort Study
Carbapenem-resistant organisms (CRO) pose a critical threat to global public health, and hospitals serve as major epicenters for their emergence and spread. Traditional clinical infection surveillance often detects CRO outbreaks only after infections have already occurred, missing the window for early intervention. Wastewater-based epidemiology has demonstrated its early warning potential during the COVID-19 pandemic and is increasingly recognized as a promising tool for antimicrobial resistance surveillance.
Our preliminary 22-day pilot study at Peking Union Medical College Hospital revealed two distinct antimicrobial resistance gene (ARG) dynamics patterns across different hospital areas: the Internal Medicine Ward exhibited a "chronic resistance background" with persistently high abundance of carbapenemase genes (IMP/GES types >5,000 ppm), while the Emergency/Fever Clinic showed "acute pulse outbreaks" characterized by transient 50- to 200-fold surges of mcr-3 and QnrVC genes. These findings suggest that hospital functional areas have fundamentally different ARG profiles with unique temporal signatures.
Read more
This prospective observational cohort study aims to establish a wastewater-based early warning system for hospital-acquired CRO outbreaks by conducting longitudinal monitoring across four key functional areas: Outpatient Building, Internal Medicine Ward, Surgical Ward, and Emergency/Fever Clinic at Peking Union Medical College Hospital over a 6- to 9-month period. Twenty-four-hour flow-proportional composite wastewater samples will be collected daily using automatic samplers. Laboratory analyses include ARG large-panel testing (300+ subtypes, daily), metagenomic sequencing (weekly, plus pulse-triggered intensified sampling), and viable bacterial culture with whole-genome sequencing of key isolates.
Concurrently, we will collect de-identified clinical CRO isolates and antibiotic consumption data (Defined Daily Doses) from the corresponding hospital buildings. Multidimensional association analyses will be performed using cross-correlation function analysis, Granger causality tests, and cgMLST-based genomic comparisons to determine the lead time of wastewater ARG signals ahead of clinical CRO diagnoses and to provide direct evidence of clonal homology between wastewater and clinical isolates. An early warning model will be constructed using dynamic thresholds (moving average + 2SD/3SD) and machine learning algorithms.
This study integrates environmental, clinical, and pharmaceutical data following the One Health framework. By establishing a replicable building-level wastewater resistome surveillance protocol, this research is expected to provide hospitals with a proactive tool for early CRO outbreak detection, enabling timely infection prevention and control measures. All clinical data will be de-identified, and the study has been designed to pose no greater than minimal risk to patients, with a waiver of informed consent sought in accordance with relevant ethical regulations.
- Conditions
- Drug Resistance, Bacterial, Carbapenems, Wastewater
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
| Study group | Role | What they receive |
|---|---|---|
| Outpatient Building | Community reference, non-hospitalized medical area | |
| Internal Medicine Ward | Chronic high-resistance background area | |
| Surgical Ward | Surgical prophylactic antibiotic use area | |
| Emergency | Acute pulse outbreak sentinel area |
What is being measured
The primary outcome is the main question the study is designed to answer.
Wastewater Antimicrobial Resistance Gene (ARG) Abundance
Abundance of 300+ ARG subtypes (including carbapenemase genes blaIMP, blaGES, blaKPC, blaNDM, blaOXA; colistin resistance gene mcr-3; quinolone resistance gene QnrVC) measured in copies per million 16S rRNA reads (ppm) from 24-hour composite wastewater samples collected at 4 hospital sites
Measured: Daily for 6-9 months
Whole-Genome Sequences of Clinical CRO Isolates
Clinical CRO isolates (50-80 selected strains) from each building during the study period are subjected to whole-genome sequencing (≥50× coverage). cgMLST typing, ARG annotation (AMRFinderPlus), and phylogenetic analysis are performed for clonal homology comparison with wastewater isolates.
Measured: Clinical CRO isolates (50-80 selected strains) from each building during the study period
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted4 Sep 2026
- Study start1 Sep 2026 (estimated)
- Primary completion1 Sep 2028 (estimated)
- Study completion1 Sep 2028 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (2)Papers the sponsor has linked to this study.
- Other trials for Drug Resistance, BacterialStudies of the same condition, open and under way.
- More trials run by Peking Union Medical College HospitalThe sponsor's other registered studies.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Observational
- Observational model
- Cohort
- Time perspective
- Prospective
- Enrolment
- 720 participants (estimated)
Sponsor and investigators
- Lead sponsor
- Peking Union Medical College Hospital
- Sponsor type
- University, hospital or other
- Responsible party
- Sponsor
- Investigators
- bin du, Dr, Principal investigator, Peking Union Medical College Hospital
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT07804433
- Sponsor's protocol ID
- PUMCH-WW-ARG-2026
- Other IDs
- 01050010
- Acronym
- WW-CRO-PREDICT
- Status last verified
- Sep 2026
- First submitted
- 1 Sep 2026
- Last updated
- 4 Sep 2026
- Results posted
- No
- Data monitoring committee
- Yes
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- Yes: De-identified metagenomic and whole-genome sequencing data will be submitted to NCBI Sequence Read Archive upon study completion, in accordance with journal requirements and data sharing policies
Publications
Liu X, Wong MKL, Zhang D, Chan DCL, Chan OSK, Chan GPL, Shum MH, Peng Y, Lai CKC, Cowling BJ, Zhang T, Fukuda K, Lam TT, Tun HM. Longitudinal monitoring reveals the emergence and spread of blaGES-5-harboring carbapenem-resistant Klebsiella quasipneumoniae in a Hong Kong hospital wastewater discharge line. Sci Total Environ. 2023 Dec 10;903:166255. doi: 10.1016/j.scitotenv.2023.166255. Epub 2023 Aug 11.
PubMed 37574056Hendriksen RS, Munk P, Njage P, van Bunnik B, McNally L, Lukjancenko O, Roder T, Nieuwenhuijse D, Pedersen SK, Kjeldgaard J, Kaas RS, Clausen PTLC, Vogt JK, Leekitcharoenphon P, van de Schans MGM, Zuidema T, de Roda Husman AM, Rasmussen S, Petersen B; Global Sewage Surveillance project consortium; Amid C, Cochrane G, Sicheritz-Ponten T, Schmitt H, Alvarez JRM, Aidara-Kane A, Pamp SJ, Lund O, Hald T, Woolhouse M, Koopmans MP, Vigre H, Petersen TN, Aarestrup FM. Global monitoring of antimicrobial resistance based on metagenomics analyses of urban sewage. Nat Commun. 2019 Mar 8;10(1):1124. doi: 10.1038/s41467-019-08853-3.
PubMed 30850636
Study at a glance
From the registry record, last updated by the sponsor on 4 Sep 2026. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Longitudinal Wastewater Monitoring of Antimicrobial Resistance Genes Across Functional Hospital Areas and Its Association With Clinical Carbapenem-Resistant Organism Infections: A Prospective Observational Cohort Study
- ClinicalTrials.gov ID
- NCT07804433
- Acronym / sponsor ID
- WW-CRO-PREDICT / PUMCH-WW-ARG-2026
- Conditions
- Drug Resistance, Bacterial, Carbapenems, Wastewater
- Study type
- Observational
- Recruitment status
- Not yet recruiting
- Enrolment
- 720 participants (estimated)
- Lead sponsor
- Peking Union Medical College HospitalUniversity, hospital or other
- Study start
- 1 Sep 2026 (estimated)
- Primary completion
- 1 Sep 2028 (estimated)
- Study completion
- 1 Sep 2028 (estimated)
- First posted
- 4 Sep 2026 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
Carbapenem-resistant organisms (CRO) pose a critical threat to global public health, and hospitals serve as major epicenters for their emergence and spread. Traditional clinical infection surveillance often detects CRO outbreaks only after infections have already occurred, missing the window for early intervention. Wastewater-based epidemiology has demonstrated its early warning potential during the COVID-19 pandemic and is increasingly recognized as a promising tool for antimicrobial resistance surveillance.
Our preliminary 22-day pilot study at Peking Union Medical College Hospital revealed two distinct antimicrobial resistance gene (ARG) dynamics patterns across different hospital areas: the Internal Medicine Ward exhibited a "chronic resistance background" with persistently high abundance of carbapenemase genes (IMP/GES types >5,000 ppm), while the Emergency/Fever Clinic showed "acute pulse outbreaks" characterized by transient 50- to 200-fold surges of mcr-3 and QnrVC genes. These findings suggest that hospital functional areas have fundamentally different ARG profiles with unique temporal signatures.
This prospective observational cohort study aims to establish a wastewater-based early warning system for hospital-acquired CRO outbreaks by conducting longitudinal monitoring across four key functional areas: Outpatient Building, Internal Medicine Ward, Surgical Ward, and Emergency/Fever Clinic at Peking Union Medical College Hospital over a 6- to 9-month period. Twenty-four-hour flow-proportional composite wastewater samples will be collected daily using automatic samplers. Laboratory analyses include ARG large-panel testing (300+ subtypes, daily), metagenomic sequencing (weekly, plus pulse-triggered intensified sampling), and viable bacterial culture with whole-genome sequencing of key isolates.
Concurrently, we will collect de-identified clinical CRO isolates and antibiotic consumption data (Defined Daily Doses) from the corresponding hospital buildings. Multidimensional association analyses will be performed using cross-correlation function analysis, Granger causality tests, and cgMLST-based genomic comparisons to determine the lead time of wastewater ARG signals ahead of clinical CRO diagnoses and to provide direct evidence of clonal homology between wastewater and clinical isolates. An early warning model will be constructed using dynamic thresholds (moving average + 2SD/3SD) and machine learning algorithms.
This study integrates environmental, clinical, and pharmaceutical data following the One Health framework. By establishing a replicable building-level wastewater resistome surveillance protocol, this research is expected to provide hospitals with a proactive tool for early CRO outbreak detection, enabling timely infection prevention and control measures. All clinical data will be de-identified, and the study has been designed to pose no greater than minimal risk to patients, with a waiver of informed consent sought in accordance with relevant ethical regulations.
Study design
- Observational model
- Cohort
- Time perspective
- Prospective
- Number of arms
- 4
| Arm | Type | Receives |
|---|---|---|
| Outpatient Building | – | –Community reference, non-hospitalized medical area |
| Internal Medicine Ward | – | –Chronic high-resistance background area |
| Surgical Ward | – | –Surgical prophylactic antibiotic use area |
| Emergency | – | –Acute pulse outbreak sentinel area |
Who may qualify
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Child, Adult, Older adult
- Study population
- Environmental samples: 24-hour composite wastewater samples from 4 designated sewer manholes (Outpatient Building, Internal Medicine Ward, Surgical Ward, Emergency/Fever Clinic) at Peking Union Medical College Hospital. Clinical data: De-identified CRO-positive culture results from patients treated in the above 4 hospital buildings during the study period.
Key inclusion criteria (4 listed)
- Wastewater samples collected from the four designated sampling sites (Outpatient Building, Internal Medicine Ward, Surgical Ward, and Emergency/Fever Clinic).
- 24-hour composite samples collected using automatic samplers following the flow-proportional mixing protocol.
- Clinical data: Patients with laboratory-confirmed CRO infection (carbapenem-resistant Enterobacterales, Pseudomonas aeruginosa, Acinetobacter baumannii, etc.) from the above 4 hospital buildings during the study period.
- Clinical data de-identified at the time of extraction.
Key exclusion criteria (4 listed)
- Wastewater samples from sites other than the four designated locations.
- Samples contaminated or degraded during collection, transport, or storage.
- Clinical data: CRO-positive results indicating colonization rather than infection.
- Clinical data with incomplete key information (species, specimen source, date of detection, or department/location).
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Primary outcome
Wastewater Antimicrobial Resistance Gene (ARG) Abundance
Time frame: Daily for 6-9 months
Abundance of 300+ ARG subtypes (including carbapenemase genes blaIMP, blaGES, blaKPC, blaNDM, blaOXA; colistin resistance gene mcr-3; quinolone resistance gene QnrVC) measured in copies per million 16S rRNA reads (ppm) from 24-hour composite wastewater samples collected at 4 hospital sites
Whole-Genome Sequences of Clinical CRO Isolates
Time frame: Clinical CRO isolates (50-80 selected strains) from each building during the study period
Clinical CRO isolates (50-80 selected strains) from each building during the study period are subjected to whole-genome sequencing (≥50× coverage). cgMLST typing, ARG annotation (AMRFinderPlus), and phylogenetic analysis are performed for clonal homology comparison with wastewater isolates.
Results and safety
This study is still under way. Results are not available in the source record yet.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 4 Sep 2026.
- Background: PubMed 37574056Liu X, Wong MKL, Zhang D, Chan DCL, Chan OSK, Chan GPL, Shum MH, Peng Y, Lai CKC, Cowling BJ, Zhang T, Fukuda K, Lam TT, Tun HM. Longitudinal monitoring reveals the emergence and spread of blaGES-5-harboring carbapenem-resistant Klebsiella quasipneumoniae in a Hong Kong hospital wastewater discharge line. Sci Total Environ. 2023 Dec 10;903:166255. doi: 10.1016/j.scitotenv.2023.166255. Epub 2023 Aug 11.
- Background: PubMed 30850636Hendriksen RS, Munk P, Njage P, van Bunnik B, McNally L, Lukjancenko O, Roder T, Nieuwenhuijse D, Pedersen SK, Kjeldgaard J, Kaas RS, Clausen PTLC, Vogt JK, Leekitcharoenphon P, van de Schans MGM, Zuidema T, de Roda Husman AM, Rasmussen S, Petersen B; Global Sewage Surveillance project consortium; Amid C, Cochrane G, Sicheritz-Ponten T, Schmitt H, Alvarez JRM, Aidara-Kane A, Pamp SJ, Lund O, Hald T, Woolhouse M, Koopmans MP, Vigre H, Petersen TN, Aarestrup FM. Global monitoring of antimicrobial resistance based on metagenomics analyses of urban sewage. Nat Commun. 2019 Mar 8;10(1):1124. doi: 10.1038/s41467-019-08853-3.
- Individual participant dataSharing planned: Yes. De-identified metagenomic and whole-genome sequencing data will be submitted to NCBI Sequence Read Archive upon study completion, in accordance with journal requirements and data sharing policies
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part.
bin du, Dr principal investigator
Peking Union Medical College Hospital
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
An observational study of Drug Resistance, Bacterial and Carbapenems, run by Peking Union Medical College Hospital at 1 site in China.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 4 inclusion and 4 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: opening soon, as of the sponsor's last update on 4 Sep 2026. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in China. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
This study is still under way. Results are not available in the source record yet.
How can a doctor refer a patient or contact the research team?
Contact yuda fei, Dr (+86 18501360830, fei_yuda@!63.com), or a site near the patient. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Wastewater Antimicrobial Resistance Gene (ARG) Abundance (time frame: Daily for 6-9 months). The study lists 2 primary outcomes in all. It is what the study was designed to measure, not a finding.
Where can I read the original study information?
On the ClinicalTrials.gov record for NCT07804433, which also lists 2 linked publications.
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 4 Sep 2026.