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Carl-Fredrik Flach


Department of Infectious
Visiting address
Guldhedsgatan 10
41346 Göteborg
Postal address
Su sahlgrenska
41345 Göteborg

About Carl-Fredrik Flach

Ongoing projects:

Antibiotic resistant bacteria in sewage and dissemination to the environment The project is funded by the Swedish Research Council FORMAS (4.6 MSEK) for the period 2015-2017 and led by Carl-Fredrik Flach. Sewage environments have been identified as risk environments for the development and transmission of antibiotic resistant bacteria. In order to reduce risks, both pre-treatment of hospital sewage as well as add-on treatment techniques at sewage treatment plants are discussed in Sweden and elsewhere. To provide guidance for the decision-making process whether, and if so where, additional treatment of sewage should be implemented regarding the risk for antibiotic resistance dissemination, this project will address the following questions; 1) Which major antibiotic resistance threats are present in treated sewage in Sweden and to what extent? 2) Are hospitals major contributors the antibiotic resistant pathogens found in municipal sewage treatment plants? 3) What are the risks for transfer of resistance factors to pathogens in municipal, hospital and treated sewage?

Resistance surveillance via analyses of hospital effluents Research supported by regional ALF-funding, i.e. funding for clinical research from the Västra-Götalands regionen. The project is funded with 0.85 MSEK per year between 2015 and 2017. The application group consisted of Joakim Larsson (Biomedicine), Carl-Fredrik Flach (Biomedicine), Christina Åhrén (Strama) and Erik Kristiansson (Chalmers). The collaboration with the local Strama-organization (Swedish Strategic Program against Antibiotic Resistance) at three major hospitals in the region (SU, SKAS, SÄS) is very important for the project. Sewage samples can be seen as pooled feces samples from a large number of individuals. As a complement to traditional patient-based screening, effluent-screening therefore has a potential to rapidly identify trends in the resistance situation to a low cost. Such information can provide input to changes in recommendations of antibiotics use as well as initiate measures to limit dissemination. In this project we will develop and evaluate methods (culturing, metagenomics, PCR, plasmid capture) to quantify selected resistant pathogens, resistance genes and resistance plasmids. Comparisons will be made with patient screening cultures and clinical isolates as well as local antibiotic use.

Expanding resistance surveillance via analyses of sewage to low income countries Research supported by CARe from 2016. The project will involve Carl-Fredrik Flach, Joakim Larsson, Rune Andersson and other PIs from CARe in addition to many international partners. This project builds on the experiences from the regional ALF-project on hospital effluent described above, but aims to apply and transfer the technology to other countries, particularly those where regional surveillance systems are weak. During 2016 we will start working in Kenya (Dr Carl-Johan Svensson) and we plan to expand to several more countries. The plan is to involve medical students during their exam-projects.

The role of antibiotics in the environment for the emergence, selection and transfer of antibiotic resistance Research project funded jointly by the Swedish Research Council VR (Medicine and Health) (0.7 MSEK/year) and the Swedish Research Council FORMAS (1 MSEK/year) for the period 2016-2018. The project is coordinated by Joakim Larsson. Carl-Fredrik Flach, Jerker Fick (Umeå University) and Erik Kristiansson (Chalmers) are co-applicants. Harmless environmental bacteria serve as sources for antibiotic resistance genes and resistance plasmids that over time are recruited into human pathogens through horizontal gene transfer. There is a widespread concern that very low, environmental levels of antibiotic residues, derived from human usage, exert selection and increase the risks for such transfers events. In some contrast to this concern, we conclude that there is still very limited scientific evidence supporting this risk scenario. By defining concentrations that select for resistance and drive gene transfer in complex microbial communities, we will investigate if resistance promotion primarily, or even only, takes place at higher environmental antibiotic concentrations reached through other routes than via human excretions, such as pollutionfrom antibiotic manufacturing. We will also investigate if industrial pollution with antibiotics promotes the emergence of previously unknown resistance factors. We expect the results to significantly improve our scientific understanding of the role of antibiotics in the environment in the emergence, selection and transfer of antibiotic resistance. Importantly, the research will aid in scaling and directing countermeasures to where they are likely to have an impact, and thereby benefit public health in the long term.