Log in
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.
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.
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.
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.
Novel bioluminescent bacterial biosensors developed at UWE, Bristol, and commercialised by Randox, have been used by a range of companies to demonstrate effectiveness of drugs and decontamination procedures. This has improved development processes at companies including Clavis Pharma, Purest Solutions and Dycem, leading to new manufacturing processes and quality control test methods. The biosensors are used in novel applications to give pharmacodynamic data on effectiveness of drugs and real time in-situ demonstration of effectiveness of decontamination processes. These biosensors, pioneered and developed by Vyv Salisbury's group, have been commercially adopted and used for evaluation by at least six collaborating companies.
Healthcare-associated infections (HCAI) and antimicrobial resistance pose a constant threat to patients accessing healthcare in a range of settings. HCAI prolong recovery; delay discharge from hospital and, in extreme circumstances, cause serious disability or death. This case study describes the impact of the Epic (evidence-based practice in infection control) research programme that focuses on the translation of evidence into national infection prevention and control guidelines for the NHS. Through evaluation of initiatives to reduce the threat of HCAI and associated disability to patients, and by generating evidence to support the development of government policy, Epic has led to safer care for people during periods of health-related vulnerability, and saved lives.
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.
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.