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Methicillin-resistant Staphylococcus aureus (MRSA) are strains of bacteria which are resistant to a range of commonly used antibiotics and as a result are difficult to treat and cause significant morbidity and mortality amongst hospitalised patients and individuals with compromised immunity. Research conducted by Professor Peter Hawkey at the University of Birmingham has demonstrated that by rapidly screening patients for MRSA on hospital admission and then using an effective decolonisation treatment, the rate of MRSA acquisition can be significantly reduced. The Department of Health (DoH), who commissioned the research, used the results of the work to formulate guidance, which was published in 2008, for universal MRSA screening in England. This has contributed to the sustained reduction in MRSA infection in England, which is indicated by the fall in MRSA bacteraemia rates from 7,274 in 2002 to 1,185 in 2011 (-83.7%).
Two significant impacts have resulted from King's College London (KCL) research on preventing infections of the so-called antibiotic-resistant MRSA `superbug' associated with hospital treatment. KCL's research exemplifies NIHR's stated "end-to-end" strategy for translating discoveries made in individual infections to population benefit through treatment and prevention.
First, KCL research contributed to Department of Health guidelines. Following the publication of those guidelines, NHS Trusts set out stronger procedures for screening patients for MRSA and for routine `decolonisation' — involving the use of antibacterial shampoo, bodywash and nasal cream by patients. This made a major contribution to the dramatic 75% fall in MRSA cases reported by Public Health England between 2008/09 and 20012/13.
Second, KCL research showed that some MRSA strains are more easily transmitted and more virulent than others. Specifically, we identified a molecule produced by one such strain of bacteria that enabled it to adhere to and colonise a host. We patented this molecule as a rational vaccine component to prevent MRSA infection, and the Novartis pharmaceutical company took up this patent in 2009.
Healthcare Associated Infections (HAI) can be an unintended consequence of healthcare delivery. They are caused by a range of organisms but are often preventable. GCU-led research has reduced avoidable infections in healthcare in the UK and Europe by stimulating policy debate and investment in new healthcare practice and influencing policy decisions, evidence guidelines, and educational practices. Important changes have been made to national and international approaches to meticillin-resistant Staphylococcus aureus (MRSA) screening with cost savings of £7.5 million to the NHS. 28 European countries now use the HAI point prevalence survey validation method determined by our research.
Professor James and colleagues developed a comprehensive, multi-strand strategy for control of healthcare-associated infections caused by life-threatening bacterial superbugs Clostridium difficile (C.diff) and methicillin-resistant Staphylococcus aureus (MRSA). Founded on research to understand the transmission, virulence and antibiotic resistance of these species, their approach resulted in: (i) increased public awareness of healthcare associated infections; (ii) changed behaviours of the public and healthcare professionals to reduce transmission; (iii) improved national healthcare policies to control infections; and (iv) development of new antibiotic methods to tackle the rapidly-evolving resistance. The outcome is a nationwide decline in reported cases of C.diff and MRSA infections in patients since 2008, with consequent economic benefits to the NHS, Government and employers.
Antibiotic resistance has become one of the great challenges to human health in the 21st century with increasing numbers of isolates of many pathogenic bacteria being resistant to front line, therapeutic antibiotics. Recent evidence has suggested that antibiotic resistance can be selected by exposure to biocides, which are commonly used as disinfectants and preservatives.
Research at the University of Birmingham has shown the common mechanistic links between antibiotic and triclosan (a commonly used biocide) resistance. This research was used by the European Commission as evidence to support two reports published in 2009 and 2010 to inform opinions as to the safety of biocide use. These reports recommended specific new research avenues be funded and that possible selection of antibiotic resistance by biocides is a valid concern and were used as part of the evidence base in preparation of a new law which has come in to force across the European Union.
Biocide use and sales in Europe have been controlled by the Biocidal Products Directive since 1998. This legislation has been superseded by the EU Biocides Regulation (published May 2012, legally binding from September 2013). This new legislation now includes a requirement for new biocides to be demonstrated not to select resistance to themselves or antibiotics in target organisms before achieving registration; this addition was informed by University of Birmingham research. This will prevent biocides entering the environment that exert a selective pressure and favour the emergence of mutant bacteria with increased biocide and antibiotic resistance. Thus the research described has had an impact on policy debate and the introduction of new legislation.
MMU Researchers were the first to develop a novel method of microbial identification using intact bacterial cells and MALDI-TOF-MS (matrix assisted laser desorption ionisation, time of flight mass spectrometry). The research laid the foundations for the development of a new commercial microbial identification system that is now being purchased in diagnostic, pharmaceutical and other applied microbiological laboratories. The system allows real time identification of isolated organisms, reducing the diagnosis time by at least 24hours.
The huge patient benefit and clear potential to save many lives comes with economic gains already evidenced by sales of 800 units at circa £100k per unit in 2011 and 2012, delivered globally to microbiology laboratories by one of two companies selling the system. The ultimate potential of the market of laboratories seeking empowerment is estimated at £10bn.
Cardiff Researchers in 2009 discovered the new antibiotic resistance determinant NDM-1 and in 2010/11 characterised its rapid worldwide spread through Gram-negative bacteria (e.g. Escherichia coli and Vibrio cholerae). NDM-1 redefined how antibiotic resistance can spread locally and internationally and create new extensively-drug resistance (XDR) that severely limits therapeutic options. This discovery has resulted in: 1) new policies for the admission of overseas patients to hospitals in the UK, France, USA, Australia and China, 2) linkage between MDR transmission and poor sewerage treatment, 3) potable water treatment in Southern Asia 4) positioning papers for the World Health Assembly and 5) policy-changes by the World Health Organisation.
Clostridium difficile infection (CDI) is a frequent and often fatal hospital-acquired infection. In the past, the diagnosis of CDI has been inadequate. This has had serious consequences for the management and control of infection in healthcare settings. Planche and colleagues at St George's have developed and validated a new diagnostic algorithm for CDI. This has led to policy changes in the UK Department of Health, and amongst European and US authorities, and to practical changes in the way CDI is diagnosed. Its implications for the successful understanding and management of this infection have been profound.
Bristol University's School of Veterinary Sciences, a global leader in feline medicine, was the first UK centre to develop and commercially offer polymerase chain reaction (PCR) and quantitative (q) PCR assays to detect a range of feline infectious and genetic diseases. Since 2008 there has been a dramatic increase in the number of qPCR tests performed, with over 35,000 tests carried out between 2008 and 2013. The results of genetic testing have informed breeding programmes and resulted in a reduced prevalence of genetic disorders such as polycystic kidney disease (PKD). The results of testing for infectious diseases have informed diagnosis and treatment modalities and, together with the genetic testing, have contributed to significant improvements in feline health and welfare. This work has also generated commercial income in excess of £1.7M, which has been used to further research into feline infectious and genetic diseases.
Atlas Genetics Ltd is a University of Bath spin-out company established in 2005 by Dr John Clarkson, a former lecturer in the Department of Biology and Biochemistry (DBB). In collaboration with DBB researchers, Atlas Genetics developed novel technology for rapid (<30 minute) and robust detection of infectious diseases at the point-of-care. Atlas Genetics has raised over £22m funding specifically to develop the Atlas ioTM detection system, which combines a patented electrochemical detection system with probes for specific micro-organisms within a small disposable cartridge. Different probe cartridges are used to detect a range of pathogens that have critical clinical importance and large-scale socio-economic significance, including Candida, methicillin resistant Staphylococcus aureus (MRSA), bacterial meningitis, and sexually transmitted diseases (STDs) Trichomonas, Chlamydia and Gonorrhoea. Candida research in DBB underpinned the specificity, sensitivity and application of the technology to clinical samples and was used in seeking capitalization for Atlas.
Atlas Genetics re-located from the University to a nearby business park and employs 35 full-time staff, some having moved from academia into the company largely thanks to the synergistic relationship with University of Bath researchers. The ioTM platform has undergone successful clinical tests on Chlamydia and Trichomonas at Johns Hopkins University, USA. The ioTM platform and Chlamydia test is scheduled for clinical trials in 2014, with roll out in Europe and the USA, pending regulatory approval, providing global reach within the $42bn in vitro diagnostics market.