"AMR research is needed to improve clinical practice and patient care including: point of care diagnostics for pathogens/antibiotic resistance; AMR surveillance to inform empiric guidance; appropriate regulation and access to suitable antibiotics globally."
The burden of antimicrobial resistance (AMR) on human health is immense – nearly 5 million deaths are estimated to have been associated with drug resistant infections in 2019, and this is predicted to rise to over 10 million deaths by 2050. With this staggering figure presented to us, we ask ourselves what can be done to prevent this inevitability?
Practitioners in clinical and veterinary medicine act as gatekeepers of access to antibiotics for use in humans and animals. They are responsible for prescribing and administering antimicrobial drugs to patients, after an assessment of their symptoms and test results. The choices made at the patient level are only one part of the complexity that contributes to AMR. However, these are important choices.
We all live in harmony with our microbiota, over 30 trillion bacteria that live on our skin, in our gut and other parts of our body. It is often these bacteria that go on to make us sick, after breaching our natural barriers, causing sepsis, meningitis, urinary tract infections or pneumonia. Our microbiota is exposed to everything that we ingest, and in particular antibiotics that act as a selection pressure in this environment to drive AMR.
Of course, it is not just overuse or misuse of antibiotics that can cause these problems, AMR circulating in environmental reservoirs related to animal or agriculture antibiotic use can also lead to human ill-health due to poor water, hygiene and sanitation practices. The problems and solutions are multi-factorial and inter-disciplinary.
Areas of active research
Research in clinical and veterinary sciences is needed to better understand antimicrobial use and resistance, and the link between them, to improve clinical outcomes and to minimise the development and spread of AMR. Researchers at LSHTM are involved at many points, some highlights are described here.
- Improved diagnostic stewardship identifying the risk/incidence of infectious illnesses such as in the PERFORM and FIEBRE studies which additionally assesses the tools to confidently diagnose infection.
- Optimising diagnostic and treatment options for MDR infections including tuberculosis is important, particularly as our antibiotic pipeline is very limited.
- Surveying the burden of AMR across geographies informs our assessment of risk in individual patients and also treatment options, for developing guidance as part of antimicrobial stewardship programmes. The MBIRA study aims to assess AMR organisms casing sepsis in seven sub-Saharan African countries. The KlebNET Genomic Surveillance Programme develops infrastructure for Klebsiella pneumoniae, a WHO priority pathogen.
- Use of infection prevention and control interventions in animal husbandry to reduce the spread of AMR can also impact the wider flow of AMR determinants in environmental reservoirs and the OneHealth context.
- We host Fleming Fund Fellows at LSHTM, who are supported by UK aid to address the determinants of AMR across 25 African and Asian countries. We are always interested to hear about and learn from their projects.