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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.
Research by Cardiff University is contributing to initiatives within the NHS and across Europe to safely reduce unnecessary antibiotic prescribing and thus help contain antimicrobial resistant bacteria. Our researchers conducted observational studies of prescribing patterns linked to local resistance data and qualitative research with GPs and patients on their perceptions of acute respiratory tract infections and antibiotic use and resistance. This enabled the Cardiff team to develop clinician training and patient education resources (covering issues such as communication skills, point of care testing, and typical duration of infections) to reduce unnecessary prescribing. Our trials proved these interventions were effective, at times cutting prescribing by as much as two-thirds. Our research has provided the basis for new clinical guidelines, antibiotic stewardship initiatives and policies, and educational tools for clinicians and patients that are being used in the UK and internationally.
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 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.
Researchers at the University of Brighton (UoB) have developed innovative low-cost solutions to pressing global disease problems. In Haiti, rapid deployment of new wastewater technology averted further human crisis when the 2010 earthquake exposed water resources to hospital wastewaters contaminated by the cholera pathogen. In Malawi, the re-design and improved management of rural wells have provided low-income communities with safer drinking water. In Europe, new methods have identified human faecal contamination of rivers and established viral removal rates in a wastewater reuse system, enabling two water companies and two national environmental agencies to meet international standards and protect public health.
Research by Professor Laura Piddock at the University of Birmingham has shown that the use of fluoroquinolone antibiotics in veterinary medicine can select for antibiotic resistance in certain strains of bacteria which then present a potential risk to human health. Fluoroquinolone antibiotics are widely used in human medicine to treat bacterial infections. For those patients with chronic bacterial gastroenteritis and/or an invasive infection, fluoroquinolone antibiotics are the empiric treatment of choice by GPs; resistance to these agents represents a large public health risk. The outcomes of the research have been used by policy makers to define the human risks of food borne infection from antibiotic resistant strains and have led to the review and amendment of international policy on the use of antibiotics in food producing animals, in particular the World Health Organisation (published outside of the review period) and US Food and Drug Administration (FDA). The research described has had a direct impact on international policy and the ban on the use of certain antibiotics has had an impact on the levels of fluoroquinolone resistance in bacteria isolated from food producing animals, reducing the transmission of resistant strains to humans.
A Cardiff researcher has led an International 15 year programme resulting in multiple novel findings which have led to changes in the recommended diagnosis and treatment of acquired haemophilia A (AHA). The research has, for the first time, allowed the comparison of immunosuppressive regimens for inhibitor eradication and comparison of the efficacy of treatment strategies to control bleeds. Studies led directly to the production of UK and International guidelines on the management of AHA with 14 of the 18 specific recommendations in the UK guideline being underpinned by Cardiff-led research.
Platinum Group Elements (PGE) are critical strategic metals because of their unrivalled applications in catalysts, fuel cells and electronics and cancer therapies. Research and analytical methods developed at Cardiff have impacted on exploration for new PGE deposits, and more efficient processing of PGE ores by international mining companies. A key milestone between 2009 and 2012 was the discovery of a 3 billion year old giant impact crater in West Greenland. This discovery is of major economic significance because all craters previously found in this size class are associated with multi-billion dollar mineral and/or hydrocarbon resources. It led to an intellectual property transaction worth CDN$ 2.1 million and discovery of nickel and PGE deposits in Greenland by North American Nickel Incorporated.
Genetic, biochemical and structural characterisation of drug targets in the human pathogen Streptococcus pneumoniae by Fisher and colleagues at St George's showed that antibacterial quinolones selectively target the enzymes gyrase, topoisomerase IV, or both, and led to the concept that `dual targeting' drugs minimise the emergence of drug resistance. They demonstrated the potency and the mechanism of action of besifloxacin, a fluoroquinolone developed by Bausch and Lomb which was subsequently approved by the FDA in 2009 for treatment of bacterial conjunctivitis. This has been shown to be a highly efficacious treatment with correspondingly increased usage and sales in the USA.
Research at the University of Manchester (UoM) has changed the landscape of medical care and research in fungal infections internationally. The impacts include: the world's first commercialised molecular diagnostic products for aspergillosis and Pneumocystis pneumonia (£10m investment); pivotal contributions to the preclinical development (£35m investment), clinical developments and registrations of 3 new antifungals with combined market share of ~$2 billion; one (voriconazole, 2012 sales >$750m worldwide) now first line therapy for invasive aspergillosis with improved survival of 15-20%; and internationally validated methods to detect azole resistance in Aspergillus (an emerging problem partly related to environmental spraying of azole fungicides for crop protection).