Antimicrobial resistance (AMR) is when bacterial, viral, parasitic and fungal infections evolve so that they no longer respond to existing treatments, which has major impact on our ability to combat disease. Resistance to even one antibiotic can mean serious, with the use of second-line and third-line treatments potentially harming patients by causing serious side effects such as organ failure and prolonging care and recovery. When infections are resistant to multiple antimicrobial treatments, diseases can be impossible to treat.
In 2019, WHO described AMR as one of the top ten global threats to public health as it killed at least 1.27 million people worldwide and was associated with nearly 5 million deaths. Now, globally, there are 4.95 million deaths per year that are associated with AMR. The UN estimates that if no action is taken, by 2050, drug-resistant infections could cause up to 10 million deaths each year. The economic impacts are huge, with some estimates projecting that AMR could cost up to $1 trillion annually worldwide. Low- and middle-income countries bear the burden of drug-resistant infections. Antimicrobial resistance has the potential to affect people at any stage of life, as well as healthcare, veterinary, and agriculture industries. This makes it one of the world’s most urgent public health problems.
This World Antimicrobial Resistance Awareness Week, the Institute of Infection is speaking to some of the researchers at Imperial College London working to combat this global treat. Our first blog in the series is about drug resistance and features Dr Frances Davies from the Department of Infectious Disease and Dr Elita Jauneikaite from the School of Public Health Dr Davies is an Academic Clinical Microbiologist who, in her daily practice, sees patients with infections that are increasingly difficult to treat. Her research focuses on developing new ways to tackle antimicrobial resistance. Dr Jauneikaite is the Research Lead for Priority Pathogens theme in the National Institute of Health Research Health Protection Research Unit in Healthcare Associated Infection and Antimicrobial Resistance (NIHR HPRU HCAI AMR).
Tell me about yourself and your research
FD: I am a Consultant Clinical Microbiologist, and my research is driven by the problems I see every day in my clinical practice – and sadly antimicrobial resistance is on the rise. I have two main focusses to my research from this: why do people get AMR infections? and what can we do to prevent them? For the first part, I investigate what has happened at a patient level to cause them to develop a resistant infection: is it something in their medical care or past history that has led to this? is it something to do with the antibiotics that have been tried that has been unsuccessful? or has there been a breakdown in infection prevention and control measures that have led to this? A lot of this information comes from assessing the learning from outbreaks of AMR infections and the ways antibiotic resistance is spread, methods of diagnosis, and rapid testing for diagnosis and accurate testing for AMR; not always as simple as it sounds, particularly on a large scale of a busy diagnostic lab and NHS healthcare setting. The second part – strategies to prevent infection – includes investigating novel technologies for tracking and even predicting the spread of infection, incorporating whole genome sequencing into this for improved accuracy, using antibiotics in the optimum ways, and more novel strategies such as preventing serious infection in vulnerable patients who are colonised by AMR bacteria (carriers), such as restoring healthy gut microbiota to prevent infection.
EJ: I am an Advance Research Fellow in Bacterial Genomics and Epidemiology and I am the Research Lead for the Priority Pathogens theme at the NIHR HPRU HCAI AMR. My research is focused on improving maternal and infant health and reducing global antimicrobial resistance burden. I use DNA sequencing technologies, bioinformatics, and molecular biology techniques to investigate how bacterial pathogens to adapt to combat antibiotics and how these AMR pathogens transmit from person-to-person; findings from my research help to inform patient and public health interventions.
What are the key challenges in your research area?
FD: The adoption of novel technologies into healthcare is difficult as hospitals always have to have a careful eye on the budget, and persuading finance officers that spending money will ultimately save money is very difficult.
EJ: Some of the key challenges in my research area are a lack of longitudinal multi-cohort studies with bacterial sampling at multiple points over time and collection of detailed host information over time as well; also, the lack of data from resource limited areas due to lack of funding that would increase the capacity and functionality of some of the settings.
What do you perceive as the “origins” of antimicrobial resistance?
FD: Bacteria have been around far longer than humans and reproduce very fast (around every 20 minutes for E. coli in the right conditions), and they are surprisingly good at sharing mechanisms of resistance between different species. A lot of the antibiotics we use have been developed over millennia by fungi to fight bacteria, as they have evolved alongside each other. The bacteria have already had time to develop their resistance mechanisms. We use antibiotics not only in human healthcare, but in veterinary practice and in agriculture on a vast scale – if bacteria are meeting the antibiotics derived from those they’ve met before in so many different ways, it was only a matter of time really before they managed to share the existing, and develop new, resistance mechanisms. Sir Alexander Flemming delivered just such a warning when he discovered penicillin.
EJ: Bacteria, like any other live organism, are just trying to survive, so they are adapting to used antibiotics and antimicrobials and will try to adapt to any new ones that we might have in the future. And this is due, not only to the antimicrobials being used to treat humans or animals, but also about antibiotics leaking into our environment through wastewater or similar. We therefore need to look at the AMR issue as a One Health approach, which includes human, animals, environment.
Where do you think Imperial’s strengths lie in this field?
FD: There are so many talented researchers at Imperial, with different things they bring to the fight against AMR. Without the excellent scientists to discover what is happening at a molecular level or the chemists and engineers who develop new technologies to detect, treat and prevent AMR, and the wealth of clinical staff in all different areas of practice, none of us can solve this problem on our own, and each bring something different to the field. Imperial being an Academic Health Science Centre really benefits that.
EJ: I think Imperial’s strength in the AMR field is multidisciplinary work and very strong connections and collaborations with colleagues at NHS, UKHSA and global partners. Also, Imperial regularly interacts with policymakers, and has a strong record of engaging public and patients in the discussions around AMR, challenges, and potential solution.
What solutions would you like to see in the future?
FD: I’d like to see politicians around the world unite to stop the excessive use of antimicrobials in farming, by improving global farming practices, and introducing policies to restrict antibiotic use to only on the advice of appropriately trained healthcare professionals. Without that, the problem is not going to stop, and we are going to continue to struggle to treat people when they develop AMR infections.
EJ: I am happy to see that the public are more aware about what antibiotics are and when to use them, also the importance of hand-hygiene and other preventative measures for stopping infections spreading person-to-person. This should definitely feature strongly among solutions for managing AMR, as this will help to reduce inappropriate antibiotic usage or overuse of antibiotics.
How important is an interdisciplinary approach to AMR research?
FD: It’s absolutely vital – there is no way this problem can be tackled by just one approach.
EJ: I think that an interdisciplinary approach to AMR research is extremely important as it can really provide us with some proper novel insights by linking the different analyses and synthesising results in a wholesome and coordinated way; some of these insights might be missed by just drawing the information and theoretically applying it to your dataset. I am very pleased to see that more and more interdisciplinary projects are taking place at Imperial as well as globally.
Are you optimistic that we can successfully overcome the challenges posed by AMR?
FD: Yes, but it isn’t going to be easy, and there are significant global problems that need to be addressed to halt the spread of AMR. I don’t think we’ve reached the tipping point for AMR yet, but there needs to be a global response to this – people need to acknowledge and understand the problem and act together to stop it.
EJ: Yes, it will take quite a few years or maybe decades, but I am feeling optimistic as there is more awareness of AMR amongst the public, all specialty healthcare professionals, and policymakers. As AMR is a global problem, it will need global solutions to address AMR challenges from multiple angles. But, I believe we can do it if we all work together.
Where do you see your research going in 5 years’ time?
FD: In 5 years’ time I hope we will have a better understanding of some of these areas, and we can start translating them into patient care.
EJ: I see my research combining more interdisciplinary data or results, and expanding into investigating not only individual bacterial species, but also looking into the dynamics of this species and its environment and that influencing bacterial ability to acquire AMR. I would hope that the findings from my current and future research will inform intervention measures and even maybe provide some targets for point-of-care diagnostics; all that would then help to identify patients, who need targeted interventions to help avoid AMR infections, to manage their AMR infection if they have one, or prevent AMR pathogen transmitting to other persons or environment.