Implementation of the WHO Tricycle protocol for surveillance of extended-spectrum β-lactamase producing Escherichia coli in humans, chickens, and the environment in Madagascar: a prospective genomic epidemiology study

The Tricycle protocol, proposed by the World Health Organization, aims to monitor the circulation of extended-spectrum β-lactamase (ESBL)-Escherichia coli in low-income countries. A study in Madagascar assessed the prevalence of ESBL-E coli and its intrasector and intersector circulation. The study found that ESBL-E coli was present in 30% of pregnant women, 57% of chickens, and 100% of surface waters. The study suggests that the Tricycle protocol can be implemented in low-income countries to investigate the spread of AMR from a One Health perspective.