{"id":120,"date":"2023-11-21T09:08:58","date_gmt":"2023-11-21T09:08:58","guid":{"rendered":"https:\/\/blogs.imperial.ac.uk\/institute-of-infection\/?p=120"},"modified":"2023-11-23T14:29:46","modified_gmt":"2023-11-23T14:29:46","slug":"amr-drug-resistance","status":"publish","type":"post","link":"https:\/\/blogs.imperial.ac.uk\/institute-of-infection\/2023\/11\/21\/amr-drug-resistance\/","title":{"rendered":"AMR: Drug Resistance – In conversation with Dr Frances Davies and Dr Elita Jauneikaite"},"content":{"rendered":"
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Antimicrobial resistance (AMR) is when bacteria<\/span>l<\/span>, vir<\/span>a<\/span>l<\/span>,\u00a0<\/span>parasit<\/span>ic<\/span> and fung<\/span>al<\/span>\u00a0infections\u00a0<\/span>evolve so that they\u00a0<\/span>no longer respond to existing treatments,\u00a0<\/span>which has major impact on our ability to\u00a0<\/span>combat\u00a0<\/span>disease<\/span>. Resistance to even one antibiotic can mean serious<\/span>, with the<\/span>\u00a0<\/span>use of\u00a0<\/span>second-line<\/span>\u00a0and third-line treatments\u00a0<\/span>potentially\u00a0<\/span>harm<\/span>ing<\/span>\u00a0patients by causing serious side effects such as organ failure and prolong<\/span>ing<\/span>\u00a0care and recovery.<\/span>\u00a0When infections are resistant to multiple antimicrobial treatments,\u00a0<\/span>disease<\/span>s<\/span>\u00a0can be impossible to treat.\u00a0<\/span><\/span>\u00a0<\/span><\/p>\n

 <\/p>\n<\/div>\n

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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\u00a0<\/span>nearly 5<\/span>\u00a0million deaths. Now, globally, there are 4.95 million deaths per year that are associated with AMR.\u00a0<\/span>The UN estimates that if no action is taken, by 2050,\u00a0<\/span>drug-resistant infections could cause up to 10 million deaths each year<\/span>. The economic impacts are huge, with some estimates projecting\u00a0<\/span>that<\/span>\u00a0AMR\u00a0<\/span>could cost\u00a0<\/span>up to\u00a0<\/span>$1 trillion<\/span>\u00a0<\/span>annually\u00a0<\/span>worldwide<\/span>.\u00a0<\/span>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\u2019s most urgent public health problems.\u00a0<\/span><\/span>\u00a0<\/span><\/p>\n

 <\/p>\n<\/div>\n

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This World<\/span> Antimicrobial Resistance Awareness Week<\/span>,<\/span>\u00a0the Institute of Infection is speaking to some of the researchers at Imperial<\/span>\u00a0College London working to combat\u00a0<\/span>this global treat<\/span>. Our first<\/span>\u00a0blog\u00a0<\/span>in the series\u00a0<\/span>is about\u00a0<\/span>d<\/span>rug resistance<\/span>\u00a0and features Dr Frances Davies<\/a> from the\u00a0<\/span>D<\/span>epartment of Infectious Disease<\/span>\u00a0and Dr Elita Jauneikaite<\/a> from the School of Public\u00a0<\/span>Health\u00a0<\/span>\u00a0Dr<\/span>\u00a0Davies is\u00a0<\/span>an Academic Clinical Microbiologist<\/span>\u00a0who,<\/span>\u00a0in her daily<\/span>\u00a0<\/span>practice<\/span>,<\/span>\u00a0sees patients with infections that are increasingly difficult to treat<\/span>. H<\/span>er research focuses on developing new ways to tackle antimicrobial resistance<\/span>.\u00a0<\/span>Dr\u00a0<\/span>Jauneikaite<\/span>\u00a0<\/span>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<\/a><\/span>\u00a0(NIHR HPRU HCAI AMR)<\/span>.<\/span><\/span>\u00a0<\/span><\/p>\n

 <\/p>\n

Tell me about yourself and your research<\/span>\u00a0<\/span><\/p>\n

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\u00a0<\/span><\/p>\n<\/div>\n

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FD:\u00a0<\/span>I am a Consultant Clinical Microbiologist, and my research is driven by the problems I see every day in my clinical practice – and\u00a0<\/span>sadly<\/span>\u00a0<\/span>a<\/span>ntimicrobial resistance is on the rise. I have\u00a0<\/span>two<\/span>\u00a0main focusses to my research from this<\/span>:\u00a0<\/span>why do people get AMR infections<\/span>?<\/span>\u00a0and what can we do to prevent them<\/span>?<\/span>\u00a0For the first part, I investigate what has happened at a patient level to cause them to develop a resistant infection<\/span>:\u00a0<\/span>is it something in their medical care or past history that has led to this<\/span>?<\/span>\u00a0is it something to do with the antibiotics that have been tried that has been unsuccessful<\/span>?<\/span>\u00a0or 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\u00a0<\/span>accurate<\/span>\u00a0testing for AMR<\/span>;\u00a0<\/span>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\u00a0<\/span>antibiotics<\/span>\u00a0in 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.\u00a0<\/span><\/span>\u00a0<\/span><\/p>\n<\/div>\n

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\u00a0<\/span><\/p>\n<\/div>\n

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EJ:<\/span>\u00a0<\/span><\/span>I am<\/span>\u00a0<\/span>an Advance Research Fellow in Bacterial Genomics and\u00a0<\/span>Epidemiology<\/span>\u00a0and I am the Research Lead for\u00a0<\/span>the\u00a0<\/span>Priority Pathogens theme at the\u00a0<\/span>NIHR HPRU HCAI AMR<\/span>. 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\u00a0<\/span>transmit<\/span>\u00a0from person-to-person; findings from my research help to inform patient and public health interventions<\/span>. \u00a0<\/span>\u00a0<\/span><\/span>\u00a0<\/span><\/p>\n<\/div>\n

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\u00a0<\/span><\/p>\n<\/div>\n

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What are the key challenges in your research area?\u00a0<\/span>\u00a0<\/span><\/p>\n<\/div>\n

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\u00a0<\/span><\/p>\n<\/div>\n

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FD:\u00a0<\/span>The adoption of novel technologies into healthcare is difficult as hospitals always\u00a0<\/span>have to<\/span>\u00a0have a careful eye on the budget, and persuading finance officers that spending money will\u00a0<\/span>ultimately save<\/span>\u00a0money is\u00a0<\/span>very difficult<\/span>.\u00a0<\/span><\/span>\u00a0<\/span><\/p>\n<\/div>\n

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\u00a0<\/span><\/p>\n<\/div>\n

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EJ:\u00a0<\/span>Some of the key challenges in my research area are\u00a0<\/span>a\u00a0<\/span><\/span>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.\u00a0\u00a0<\/span><\/span>\u00a0<\/span><\/p>\n<\/div>\n

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\u00a0<\/span><\/p>\n<\/div>\n

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What do you perceive as the \u201corigins\u201d of antimicrobial resistance?<\/span>\u202f<\/span>\u00a0<\/span><\/p>\n<\/div>\n

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\u00a0<\/span><\/p>\n<\/div>\n

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FD:<\/span><\/span>\u00a0<\/span>Bacteria have been around far longer than humans and reproduce\u00a0<\/span>very fast<\/span>\u00a0(around every 20 minutes for\u00a0<\/span><\/span>E. coli<\/span>\u00a0in the right conditions), and they are surprisingly good at sharing mechanisms of resistance between\u00a0<\/span>different species<\/span>. 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\u00a0<\/span>they’ve<\/span>\u00a0met before in so\u00a0<\/span>many different ways<\/span>, 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\u00a0<\/span>p<\/span>enicillin.\u00a0<\/span><\/span>\u00a0<\/span><\/p>\n<\/div>\n

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\u00a0<\/span><\/p>\n<\/div>\n

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EJ:<\/span>\u00a0<\/span>Bacteria<\/span>,<\/span>\u00a0like any other live organism<\/span>,<\/span>\u00a0are just trying to survive, so they are adapting to used antibiotics and antimicrobials and will try to adapt to any new one<\/span>s<\/span>\u00a0that we might have in the future. And this is due<\/span>,<\/span>\u00a0not only to the antimicrobials being used to treat humans or animals,\u00a0<\/span>but\u00a0<\/span>\u00a0also<\/span>\u00a0about antibiotics leaking into our environment through wastewater or similar<\/span>.\u00a0<\/span>W<\/span>e<\/span>\u00a0therefore<\/span>\u00a0need to look at the AMR issue as a One Health approach, which includes human, animals, environment.<\/span><\/span>\u00a0<\/span><\/p>\n<\/div>\n

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\u202f<\/span>\u00a0<\/span><\/p>\n<\/div>\n

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Where do you think Imperial\u2019s strengths lie in this field?\u202f<\/span>\u00a0<\/span><\/p>\n<\/div>\n

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\u00a0<\/span><\/p>\n<\/div>\n

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FD:<\/strong>\u00a0<\/span>There are so many talented researchers at Imperial, with different things they bring to the fight against AMR<\/span>. W<\/span>ithout the excellent scientist<\/span>s<\/span>\u00a0to discover what is happening at a molecular level or the chemists and engineers who develop\u00a0<\/span>new technologies<\/span>\u00a0to detect, treat and prevent AMR, and the wealth of clinical staff in all different areas of practice<\/span>,\u00a0<\/span>none of us can solve this problem on our own, and each bring something different to the field. Imperial being an\u00a0<\/span><\/span>A<\/span>cademic\u00a0<\/span>H<\/span>ealth\u00a0<\/span>S<\/span>cience\u00a0<\/span>C<\/span>entre<\/span><\/span><\/span><\/a>\u00a0<\/span>really<\/span>\u00a0benefits that.\u00a0<\/span><\/span>\u00a0<\/span><\/p>\n<\/div>\n

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\u00a0<\/span><\/p>\n<\/div>\n

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EJ:<\/strong> I think Imperial\u2019s strength in the AMR field is multidisciplinary work and\u00a0<\/span>very strong<\/span>\u00a0connections and collaborations with colleagues at NHS, UKHSA and global partners. Also, Imperial regularly interacts with policy<\/span>makers, and has\u00a0<\/span>a\u00a0<\/span>strong record of engaging public and patients in the discussions around AMR, challenges, and potential solution.<\/span><\/span>\u00a0<\/span><\/p>\n<\/div>\n

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\u00a0<\/span><\/p>\n<\/div>\n

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What solutions would you like to see in the future?\u202f<\/span>\u00a0<\/span><\/p>\n<\/div>\n

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\u00a0<\/span><\/p>\n<\/div>\n

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FD:<\/strong>\u00a0<\/span>I’d<\/span>\u00a0like 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.\u00a0<\/span><\/span>\u00a0<\/span><\/p>\n<\/div>\n

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\u00a0<\/span><\/p>\n<\/div>\n

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EJ:<\/span><\/strong>\u00a0I am happy to see that\u00a0<\/span>the<\/span>\u00a0<\/span>public are more aware about what\u00a0<\/span>antibiotics\u00a0<\/span>are\u00a0<\/span>and when to use them, also the importance of hand-hygiene and other preventative measures for stopping infections spreading person-to-person.\u00a0<\/span>T<\/span>his should\u00a0<\/span>definitely feature<\/span>\u00a0strongly among solutions for managing AMR, as this will help to reduce inappropriate antibiotic usage or overuse of antibiotics<\/span>. \u00a0<\/span>\u00a0<\/span><\/span>\u00a0<\/span><\/p>\n<\/div>\n

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 <\/p>\n

How important is an interdisciplinary approach to AMR research?<\/span>\u202f<\/span>\u00a0<\/span><\/p>\n<\/div>\n

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\u00a0<\/span><\/p>\n<\/div>\n

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FD:<\/strong>\u00a0<\/span>It’s<\/span>\u00a0<\/span>absolutely vital<\/span>\u00a0– there is no way this problem can be\u00a0<\/span>tackled\u00a0<\/span>by just one approach.\u202f\u00a0<\/span><\/span>\u00a0<\/span><\/p>\n<\/div>\n

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\u00a0<\/span><\/p>\n<\/div>\n

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EJ:<\/strong>\u00a0<\/span>I think that\u00a0<\/span>an\u00a0<\/span>interdisciplinary approach to AMR research is extremely important as it can really provide\u00a0<\/span>us\u00a0<\/span>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\u00a0<\/span>very pleased<\/span>\u00a0to see that\u00a0<\/span>more and more<\/span>\u00a0interdisciplinary projects are taking place at Imperial as well as globally<\/span>.\u00a0\u00a0<\/span><\/span>\u00a0<\/span><\/p>\n<\/div>\n

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\u00a0\u00a0<\/span>\u00a0<\/span><\/p>\n<\/div>\n

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Are you optimistic that we can successfully overcome the challenges posed by AMR?\u00a0<\/span>\u00a0<\/span><\/p>\n<\/div>\n

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\u00a0<\/span><\/p>\n<\/div>\n

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FD:<\/strong>\u00a0<\/span>Yes, but it\u00a0<\/span>isn’t<\/span>\u00a0going to be easy, and there are significant global problems that need to be addressed to halt the spread of AMR. I\u00a0<\/span>don’t<\/span>\u00a0think\u00a0<\/span>we’ve<\/span>\u00a0reached 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.\u202f<\/span><\/span>\u00a0<\/span><\/p>\n<\/div>\n

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\u00a0<\/span><\/p>\n<\/div>\n

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EJ:<\/strong>\u00a0<\/span>Yes, it will take quite<\/span>\u00a0a<\/span>\u00a0few years or\u00a0<\/span>maybe decades<\/span>, but I am feeling optimistic as there\u00a0<\/span>is<\/span>\u00a0more awareness of AMR amongst the public, all specialty healthcare professionals<\/span>,<\/span>\u00a0and policy<\/span>makers. As AMR is a global problem, it will need global solutions to address<\/span>\u00a0<\/span>AMR\u00a0<\/span>challenges\u00a0<\/span>from multiple angles.\u00a0<\/span>But<\/span>,<\/span>\u00a0I believe we can do it if we all work together. \u00a0<\/span><\/span>\u00a0<\/span><\/p>\n<\/div>\n

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\u00a0<\/span><\/p>\n<\/div>\n

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Where do you see your research going in 5 years\u2019 time?\u202f\u00a0<\/span>\u00a0<\/span><\/p>\n<\/div>\n

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\u00a0<\/span><\/p>\n<\/div>\n

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FD:\u00a0<\/span>In 5\u00a0<\/span>years’<\/span>\u00a0<\/span>time I hope we will have a better understanding of some of these areas, an<\/span>d<\/span>\u00a0we can start translating them into patient care.\u00a0<\/span><\/span>\u00a0<\/span><\/p>\n<\/div>\n

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\u00a0<\/span><\/p>\n<\/div>\n

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EJ:\u00a0<\/span>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\u00a0<\/span>acquire<\/span>\u00a0AMR. 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.<\/span><\/span>\u00a0<\/span><\/p>\n<\/div>\n

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\u00a0<\/span><\/p>\n<\/div>\n<\/div>\n<\/div>\n

<\/p>\n

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\u00a0<\/span><\/p>\n<\/div>\n","protected":false},"excerpt":{"rendered":"

  Antimicrobial resistance (AMR) is when bacterial, viral,\u00a0parasitic and fungal\u00a0infections\u00a0evolve so that they\u00a0no longer respond to existing treatments,\u00a0which has major impact on our ability to\u00a0combat\u00a0disease. Resistance to even one antibiotic can mean serious, with the\u00a0use of\u00a0second-line\u00a0and third-line treatments\u00a0potentially\u00a0harming\u00a0patients by causing serious side effects such as organ failure and prolonging\u00a0care and recovery.\u00a0When infections are resistant to […]<\/p>\n","protected":false},"author":1740,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[48173],"tags":[],"class_list":["post-120","post","type-post","status-publish","format-standard","hentry","category-uncategorised"],"yoast_head":"\nAMR: Drug Resistance - In conversation with Dr Frances Davies and Dr Elita Jauneikaite - Institute of Infection<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.imperial.ac.uk\/institute-of-infection\/2023\/11\/21\/amr-drug-resistance\/\" \/>\n<meta property=\"og:locale\" content=\"en_GB\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"AMR: Drug Resistance - In conversation with Dr Frances Davies and Dr Elita Jauneikaite - Institute of Infection\" \/>\n<meta property=\"og:description\" content=\"  Antimicrobial resistance (AMR) is when bacterial, viral,\u00a0parasitic and fungal\u00a0infections\u00a0evolve so that they\u00a0no longer respond to existing treatments,\u00a0which has major impact on our ability to\u00a0combat\u00a0disease. 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