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Brighton & Sussex Medical School

Current research: tackling Antibiotic Resistance


Current research: Tackling Antibiotic Resistance

Antimicrobial resistance (AMR) is a major global health issue. The rise in resistance rates is alarming and an increasing number of countries are reporting resistance to all of the commonly used antimicrobials, leading to untreatable fatal infections.

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Introduction

The European Centre for Disease Prevention and Control estimates that ~4,131,000 patients are affected by hospital-acquired infections every year across Europe, whereas in low- and middle income countries (LMIC) the burden is estimated to be up to three times higher, with an estimated cost of ~€7 billion per annum.  

LMICs face a range of issues, such as inadequate health systems, lack of regulation on antibiotic consumption in humans and usage in agriculture, the availability of over-the-counter drugs, counterfeit drugs, poor hygiene and overcrowded populations. A biomedical approach towards tackling this major problem (including advancing understanding of genetic mechanisms of resistance and the development of new antimicrobial agents) will not succeed in addressing AMR alone. Research requires a multidisciplinary approach that also includes human, social and behavioural determinants of antibiotic use, and the role of policy makers in their use and regulation.

Areas of research

AMR research within the Wellcome Trust Brighton and Sussex Centre for Global Health Research is rapidly expanding, investigating different issues relating to AMR, but focusing primarily on bacterial infections.

Research includes epidemiology of both Gram-negative and Gram-positive infections, genetic mechanisms of resistance, evolution and transmission in the hospital setting, as well as the community, and antimicrobial stewardship. 

An interdisciplinary project, run by Dr Leena Al-Hassan, aims to investigate the epidemiology of Gram-negative infections and characterise the main mechanisms of antibiotic resistance in different African countries, as well as looking at the role of mobile genetic elements in the transmission of resistance globally. 

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A team working with Prof Martin Llewelyn is currently looking at application of microbial genome sequencing to the study of transmission and pathogenesis of S. aureus infection and reducing antibiotic usage in hospitals through optimising treatment strategies. This is in collaboration with groups such as Modernising Medical Microbiology, the International Staphylococcus Aureus Collaboration and the NIHR-funded Antibiotic Reduction and Conservation in Hospitals (ARK-Hospital) programme. 

Multidisciplinary research, combining biomedical and social sciences, is key to addressing AMR and the Centre has been successful in setting up local and international collaborations with a similar research interest in AMR. The project Prioritising Antimicrobial Resistance: Establishing an Interdisciplinary International Research Network (IRPN) to Tackle an Evolving Global Health Threat is a research partnership between the Wellcome Trust Brighton and Sussex Centre for Global Health Research (WTBSCGHR), The Centre for Global Health Policy (CGHP) at the University of Sussex, The Institute of Global Health (ISGlobal) at the University of Barcelona, and the Institute of Medical Microbiology, Immunology and Hygiene (IMMIH) at the University of Cologne.

These institutes have different, but overlapping, research experience and the IRPN partners form a global, collaborative, research network, including Egypt, Sudan, Ethiopia, Morocco, Mozambique, Cameroon, Bolivia and Peru. The partnership aims to obtain insight into the epidemiology of resistance at a global level, expand research and learning in novel technologies in Whole Genome Sequencing (WGS) to better understand the genetics of pathogens, and to gather data on the social and policy drivers that shape the evolution of resistance.

In collaboration with the School of Global Studies and the Institute of Development Studies (IDS), a Sussex Sustainability and Research Programme (SSRP) fund was awarded to the project ‘Building global surveillance data: towards a sustainable global response to AMR’ which aims to improve the knowledge base of the global AMR response by investigating how global surveillance systems can be linked better into local health system in LMICs. The project will track the life-cycle of data that is produced in routine clinical practice and follow its trajectory in local healthcare facilities, the health system and the policy level as well as using Whole Genome Sequencing and molecular microbiology on bacterial samples from hospitalised patients.

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Future strategy

Research is required to fill the gaps in our knowledge on the burden of AMR globally, particularly in low- and middle-income countries where significant data gaps exist. Our future multidisciplinary research aims to collaborate with its partner institutions to better understand their needs for research in AMR, as well as help build capacity for local researchers. High quality data surrounding the genetic mechanisms of AMR in LMICs and how they differ from mechanisms reported elsewhere in the world needs to be identified in order to get a complete global picture. In our future research strategy, we promote capacity building, strengthening links with our partners, and promote excellent research that addresses AMR in a multidisciplinary approach.

BACKGROUND IMAGE FOR PANEL

The Sussex AMR study group

The AMR study group serves as a platform to generate transformative knowledge through interdisciplinary collaborations. We hold regular meetings to share research expertise, engage in new ways of thinking about critical issues, and to develop partnerships, projects, and publications aimed a range of audiences, in order to contribute to addressing the challenge of AMR.

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AMR Study Group