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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 at the University of Liverpool (UoL) has developed and proven a straightforward diagnostic test method for bacterial blood infections. This was urgently needed as sepsis is a medical emergency that lacks adequate and rapid diagnostic tests particularly for low cost early detection. UoL's research has demonstrated that a simple optical test that can be conducted during routine testing of coagulation is an effective diagnostic, prognostic and monitoring marker for sepsis that can be routinely applied in clinical settings. There are now established UK and international laboratory standards in place. In 2010 a spinout company was formed to exploit four patents and incorporate the technology into a point-of-care device suitable for all clinical settings. The company, Sepsis Ltd, has attracted £1.45m of investment.
Research co-led by Prof Roz Anderson, in collaboration with a multi-disciplinary team, resulted in a new chromogenic substrate for the rapid detection and specific identification of the bacterial pathogen, Pseudomonas aeruginosa, a `super-bug' that threatens many thousands of hospital patients annually, leading to poor clinical outcome and increased risk of mortality.
bioMérieux adopted the technology for a new product, ChromID® P. aeruginosa, for commercial realisation as a clinical microbiology test; it was launched in the EU, USA and Australia, supporting the company's commercial position as leaders in this field. This test has enhanced the care of patients, through more rapid detection of P. aeruginosa and earlier informed clinical decision- making.
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.
Professor William Stimson has led research into rapid diagnostic tests for the food industry from 1996 to the present day. These tests reduce the time for microbiological testing of food pathogens from 2-5 days to within a working day. The new technology is fully automated, uses less material and involves fewer manipulations than previously available kits, leading to a reduction in cost and time. A spin out company, Solus Scientific Solutions Ltd., has attracted €1.36M EUROSTARS funding for further Research & Development, and has created 24 jobs. Sales of testing kits produced revenue of £3.4 million by year end 2012, and have increased since this date.
From 1993 to 2005, Professor Errington and his colleagues at the University of Oxford addressed the increasingly serious global emergency of treating antibiotic-resistant bacteria. Their research led to the establishment in 1998 of the university spin-out company Prolysis Ltd and the discovery and development of two innovative series of antibiotics. The success of Prolysis Ltd was confirmed in 2009 when it was acquired by Biota Europe for £6.4 million, and gained an additional investment of £14.9 million. The subsequently formed Biota Pharmaceuticals Inc. continues to support the development of innovative broad-spectrum antibiotics essential to combat antibiotic-resistant bacteria.
Periodontitis is a significant public health concern affecting more than half of those over 30 years of age. Our research on light-activated antimicrobial agents (LAAAs) has resulted in the development of a novel, non-invasive therapy that quickly and safely treats periodontitis, thereby reducing antibiotic usage. This technology was developed for commercial use through a licence agreement with Ondine Biomedical and their subsidiary company PDT Inc., as a system called Periowave. Periowave is available in Canada, Mexico and South East Asia, has been granted CE marking and FDA approval is currently being sought. To date an estimated 92,000 treatment kits have been sold and 313,000 patients treated. The system has now also been adapted for use in hospitals to eradicate MRSA from the anterior nares thereby preventing post-surgical infections.
For stroke patients and any patient undergoing surgery the time period from diagnosis to treatment is a major factor in clinical outcomes. Research carried out at the University of Warwick has led to the development of sensors that can be used to measure, in whole unprocessed blood, diagnostically useful analytes that can be used to select the best therapeutic treatments. Point-of- care diagnosis and prompt referral to an appropriate care pathway, facilitated by the use of biosensors, will result in efficiency savings for healthcare professionals and the NHS in the long- term, and will also improve patient outcomes. To commercialize these biosensors, Sarissa Biomedical Ltd was founded in 2002, as a UK-based spinout from the University of Warwick. Sarissa sells, around the world, microelectrode biosensors fabricated by a unique enzyme deposition technology protected by patents filed in 2004 and 2008 by the University of Warwick. The diagnostic sensors are based on technology that incorporates Ruthenium Purple and use a sol-gel coating to entrap enzymes on a microelectrode. Sarissa is pursuing human trials of its biosensors as diagnostic tools in two main areas: stroke, and trauma with associated sepsis.
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.
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.