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Research by the University of Southampton has contributed significantly to reducing the global threat of antibiotic resistance. A series of both conventional placebo-controlled and novel open design trials has influenced a number of important national clinical guidelines for Respiratory Tract Infections (RTIs) and the implementation of novel prescribing strategies that discourage unnecessary antibiotic prescription. As a direct result of the research, delayed prescribing for all acute respiratory infections is a tool in the everyday practice of the UK's GPs. Southampton's work in this field has informed international guidelines currently in place in the United States, Israel and the European Union.
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.
Our ground-breaking research has driven major changes in non-medical prescribing (NMP) legislation. As a result of our research, over 19,000 nurses and 2,000 pharmacists now independently prescribe medicines directly to patients across the most comprehensive range of medicines in the world. This amounts to four million prescriptions per year in England. NMP has improved the quality and efficiency of health care: patients can now access prescribed medicines faster and NMP has reduced the number of professionals required. Study results have also contributed significantly to a recent extension of independent prescribing powers to physiotherapists and podiatrists. Our research is widely cited in international NMP policy development, and our survey methods and evaluation measures are used to assess NMP quality and safety internationally.
Research undertaken on prescribing strategy by the Centre for Medicines Optimisation (School of Pharmacy) is embedded in NHS policy for medicines management. Keele's bespoke reports for the West Midlands Region provided the template for national performance management of primary care prescribing. Linked educational outreach studies established the use of community pharmacists as change agents. Both of these approaches are referenced in separate National Audit Office reports. In addition, Keele piloted risk sharing between pharmaceutical companies and the NHS, now adapted in DH Joint Working Guidelines and NICE policy. Their work on effective shared care is referenced in the 2013 GMC guidance on good practice in prescribing. These principles have been adapted for their WHO government level reports.
Patient safety research from Manchester Pharmacy School at the University of Manchester (UoM) has reduced prescription errors in primary and secondary care. Pharmacists using our indicators with patients' electronic health records (aimed at preventing drug-related morbidity in general practices) reduced the odds of prescribing and monitoring problems by at least 22%. These indicators are now incorporated into `medicines optimisation' software for general practice computer systems. The EQUIP study led changes in the recommended design of hospital prescription charts, an annual national assessment of prescribing competence of medical students and the employment of extra hospital pharmacists to prevent the 9% of prescriptions with errors from harming patients.
The need to measure and improve hospital antibiotic prescribing was identified as a priority in European and UK policy documents about antibiotic resistance in the late 1990s. Our research developed sustainable methods for evaluating interventions to improve hospital antibiotic prescribing, and led to Davey collaborating with the European Surveillance of Antimicrobial Consumption (ESAC) project and becoming the Scottish Antimicrobial Prescribing Group's Representative with Responsibility for International Liaison and Research. Implementation of ESAC quality indicators and measurement methods has been associated with progressive improvement in antibiotic policy compliance and reduction in Clostridium difficile infection in all 14 Health Boards in Scotland since 2008.
This research has improved the clinical use of powerful antibiotics. New guidelines for vancomycin use in adults have been adopted by the NHS throughout Scotland and in other parts of the UK. New neonatal vancomycin guidelines have decreased the time to achieve optimal antibiotic concentrations and reduced patient trauma and staff workload. These guidelines are used routinely in the Greater Glasgow area and other parts of the UK. Tobramycin guidelines improved the management of infection in patients with cystic fibrosis in the Glasgow and Edinburgh areas. Additional studies, which investigated guideline implementation across NHS Scotland, resulted in nationally supported resources designed to improve the quality of patient care when vancomycin or gentamicin is used.
Two major national studies, conducted by staff in the Unit and colleagues from a number of other institutions, provide the most comprehensive estimate to date of the prevalence of prescribing errors in general practice in England. These studies identified a number of strategies for reducing these prescribing errors that have been endorsed by the General Medical Council (GMC). Other impacts from these studies include increased public understanding and debate through media coverage, changes to GP education to be implemented by the Royal College of General Practitioners (RCGP), improvements to computerised prescribing decision support for general practitioners and increased awareness of the medication safety role of primary care pharmacists.
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.
Research carried out at the University of Southampton has led to the development of a new tool for detecting and managing malnutrition. The Malnutrition Universal Screening Tool (MUST) has been rolled out to more than 80% of hospitals and care homes in England and 98% in Scotland, is part of national health policy in Finland and the Netherlands, and has attracted interest internationally. The National Institute for Health and Clinical Excellence bases its current quality standard for nutritional support in adults on the MUST framework; only two NICE guidelines have saved the NHS more money. MUST has become an integral part of the UK's health policy framework, embedded in routine clinical care and supported by bodies responsible for clinical and care excellence. It is central to learning programmes on managing malnutrition.