18th of November marked the start of 2021’s World Antimicrobial Awareness Week. Fighting AMR is a challenge where every member of the public, every patient and every healthcare worker has their role to play. The ICSM Gazette sat down with Juliet Alibone and Dr. Esmita Charani from Imperial College London’s own Health Protection Research Unit (HPRU) in Healthcare-Associated Infections and Antimicrobial Resistance, to find out more about this critical issue and find out about the work that’s being done to combat it.
Could you give us a brief introduction to the WAAW campaign and it’s importance/aims?
WAAW is a campaign by the World Health Organisation which aims increase awareness of global antimicrobial resistance (AMR) and encourage everyone to do their bit, whether that is as a healthcare worker responsible for prescribing antibiotics, or as a member of the public or a carer who might need to take antibiotics, or as a farmer or pet owner who might use them on their animals. AMR effects everyone, across the globe in one way or another.
Can you take us through all that’s been going on in this year’s campaign in Imperial?
This year WHO came up with a fantastically visual idea for people to show their support: #GoBlueForAMR. So in addition to all the amazing academic talks and seminars our staff were doing, they also took lots of pictures of themselves wearing, blue, their students in blue, their pets in blue, we even managed to make the Queen’s Tower go blue. We also pulled together a couple of great videos around AMR- one featuring children of the Unit’s staff at a “high level AMR meeting” and another in multiple languages with AMR messages which really highlighted the diversity of our staff and students. Both can still be seen on our twitter feed (@HPRUamr), the one with the kids was retweeted by Dame Sally Davies, UK AMR Envoy so that was fantastic! This year we launched the first of our public facing computer games around AMR, called “Dicing with Death”, it’s basically snakes and ladders, but this time good infection prevention behaviours, like washing your hands, only taking antibiotics as prescribed and getting vaccinated see you going up ladders and the bad ones see you sliding down to snakes. Usually at this time of year, we would have had pop up stands across campuses and an antibiotic amnesty prize draw where people can return unused antibiotics for safe disposal, sadly with fewer people on campus due to COVID-19 we didn’t run it, but some pharmacies across the Midlands ran something similar, and New Zealand did it Nationally last year or the year before, but we were there with the idea first!
How big a threat does AMR and HAIs pose to the future of global health?
Where to start! We, collectively, are finally waking up to the damage we have done to the environment for generations by not respecting nature and starting to wake up to the potential catastrophic repercussions of those actions. AMR is a threat on a par with climate change; antibiotics are a precious resource, but we have been squandering them, by overusing them and misusing them and ignoring the natural consequences of those actions. The consequences are that a whole range of bacteria are now resistant to the drugs of last resort. Illnesses which were curable are increasingly becoming incurable and many of the huge advances in modern medicine which we take for granted; hip replacements, caesarean section, cancer treatment, organ transplants will all stop being possible without working antimicrobials. The last Chief Medical Officer, Dame Sally Davies, said that without working antimicrobials, medicine would go back to the dark ages.
What do you think most people misunderstand when it comes to AMR? If you could get one message about AMR into every household what would it be?
It’s a complicated subject, so people tend to think it is they who become resistant to antibiotics, but that isn’t correct. It’s the bacteria causing diseases that become resistant and then they can pass that resistance gene to other bacteria, including ones which aren’t even the same species.- As we have seen with the COVID-19 virus, disease causing pathogens travel quickly and don’t respect borders, so resistance in one part of the world is quickly seen in another. The other common misconception is that if we discover a new antibiotic, we have solved the problem of drug resistance, but that’s not right either. Resistance is simply evolution in action- every new antibiotic will have some bacteria that will be naturally resistant, furthermore with exposure to the new antibiotic other bacteria may learn to develop resistance through natural selection- all you can do it try and slow-down that resistance by not using antibiotics unless really necessary thus reducing selection pressure. My one message would be, before you go to the doctor to ask for antibiotics, consider whether you really need them. Most common colds are viral, so antibiotics wouldn’t work anyway, and lots of infections whether bacterial or viral are self-limiting. Yes, you will feel grotty, but often it’s better to treat the symptoms and let your immune system do its thing. I mean, if you were given a ration of antibiotics to use during your lifetime and that was it, would you really use them to treat a nasty cold because you wanted to be well for lectures, or would you stay in bed for a couple of days and get better and save the need antibiotic for the time you might really need them for example if you needed to have an operation when you’re older or for chemotherapy? We need to change how we think about antibiotics, they really aren’t a limitless resource.
Can you give us an overview of the research your HPRU unit has been conducting?
Our Unit is multidisciplinary because AMR is such a complex problem. First we have the bench-scientists looking at genomic microbiology – what makes a bacteria resistant to certain antibiotics, why are some types of resistance more transmissible than others, why are some more deadly, how can you identify one strain from another. This work will be a lot more familiar to people now post-COVID, since we’ve heard a lot about genomics and how important it is in tracking disease emergence and spread and for designing treatments. Then we have data scientists and modellers who use data from different areas including genomics, national databases, local or hospital level health record systems, to predict risk and the spread of drug resistant infections or to see the impact of policy decisions on patient outcomes. Concurrent to this we have other teams looking at the problem from the the drugs we prescribe. How do we get people to prescribe antibiotics more accurately and have better infection prevention strategies? This work consists of two strands, one looking at the behavioural and social angle of how and why people make the decisions they do and another looking at the technical and design aspects of what innovations and developments we can come up to make this all easier! So, we are doing some very clever things looking across the breath of the issue- from social sciences, to precision prescribing, to epidemiology and bacterial genomics.
There is currently a global disparity in AMR. How does the HPRU’s research address this?/What steps must be taken to address this?
There are many sociocultural inequities in healthcare which influence how people access health and their ability to live healthy lives. These inequities will impact infection related outcomes. Access to clean water, vaccines, healthcare facilities and quality assured medicines, including antibiotics vary between countries. Lack of access to these key indicators can lead to increased infection burden in populations as well as increase the risk of the emergence and threat of AMR. Within countries poverty, poor housing, education, occupational insecurity all impact health. Furthermore race, ethnicity and gender can also influence health and illness. At the Imperial HPRU we are researching the impact of infections and AMR in vulnerable populations to ensure that the healthcare needs of all the different subsets of the population are taken into consideration when developing solutions to tackle AMR. This includes understanding how we can better reach to different communities and provide equitable access to health and health information. Globally we are building collaborations with colleagues in in centres, including France, Norway, South Africa, Pakistan, India, and Uganda to be able to learn from each other and build capacity for sustainable research. Together with our colleagues around the world we have developed open, free learning resources on online platforms to share not only the findings from the research we carry out, but also the methodologies we employ. More importantly, we also actively participate in and encourage cross-collaborations through our researchers (PhD studentships, internships, visiting researchers).
How can we help combat AMR as future doctors?
We encourage students to get involved in our research, as that is one way for you to learn about the work we do and to imbibe the principles of the need for optimised antibiotic use early on. If you are interested in our research and want to find out how you can get involved email (firstname.lastname@example.org). As future doctors, regardless of the path you choose or the specialty you end up in, you will be required to diagnose and treat infections with antibiotics. It is important to understand that as future prescribers, you will have an important role in shaping our response to AMR. However, you won’t work in isolation and building strong working relationships with other members of the multidisciplinary teams you work within will be vital to address the problem of AMR. What’s important to do is begin to appreciate that antibiotics are a finite resource, and they need to be used responsibly. Doctors work alongside nurses, pharmacists and laboratory experts to try to make the best decisions for their patients and this is something that is vital to address AMR. Remember this and always seek advice from colleagues who may be able to support you. Additionally make sure that you are familiar with local and national evidence-based recommendations and guidelines to guide your decision making when managing infections.