AMR burden

AMR burden and surveillance

The global burden of AMR is increasing, yet there is still a lack of accurate data on the burden of common antimicrobial-resistant infections, particularly from low- and middle-income countries (LMICs). At the IOI, we undertake international, collaborative studies with global surveillance and assessment programmes to understand the impact of AMR on health and agricultural structures across LMICs.

These activities combine our multi-disciplinary expertise in epidemiology, clinical medicine, cellular and molecular microbiology, genetics and genomics, enabling us not only to assess AMR burden but also explore mechanisms of drug resistance and link these to clinical outcomes.

Ongoing projects include investigating the burden of antibiotic resistance in neonates from developing societies (BARNARDS), comparing the burden of AMR and treatment failure in low-, middle- and high-income countries (BALANCE), examining the impact of COVID-19 on bacterial sepsis, antimicrobial usage and resistance (COVID-19/DRI), and investigating the role of arthropods (flies and insects) on AMR spread (AVIAR).

AVIAR

Arthropods as vectors of infection and AMR

While the misuse of antibiotics in human medicine and agriculture are key contributors to the global rise and spread of AMR, there are many additional factors that could relate to AMR dissemination, including the role played by arthropods (including spiders, flies and cockroaches) on the transmission of drug-resistant bacteria.

Previously, we combine patient demographics, comprehensive sampling in two seasons (summer to winter) and in-depth genomics to demonstrate a role for arthropods as vectors of multidrug-resistant bacteria in surgical site infections in Peshawar, northern Pakistan. We are now expanding these studies, to include additional clinical sites, to characterize a range of arthropods sampled globally, and to investigate the contributions of arthropods to AMR transmission outside of the clinical environment.

BALANCE

Burden of AMR and treatment failure in low-, middle- and high-income countries

The ‘BALANCE’ study aims to estimate the health and economic burden of AMR in pediatric and adult populations, comparing low- and middle-income countries (LMICs) and high-income countries (HICs). Focusing on Bangladesh, Kenya, Nigeria, Pakistan, Sierra Leone, Israel, Italy, Poland and Singapore, the study integrates high-quality demographic, socioeconomic, epidemiological, clinical, microbiology and genomic data through a capacity-building approach.

This study is complementary to the capacity-building activities of the Fleming Fund in LMICs, which include laboratory refurbishment, support and training across 24 countries in both human and animal AMR health, including one-health AMR. BALANCE will further support laboratory and/or clinical staff to analyze the burden of critical infections and to understand the economic impact both in patient care as well as antibiotic accessibility and affordability.

BARNARDS

Burden of antibiotic resistance in neonates from developing societies

Neonatal sepsis is one of the leading causes of infant mortality, particularly in LMICs, and is commonly linked to drug resistance. However, the burden and mechanisms of AMR linked to neonatal sepsis remain poorly explored, particularly in rural areas where healthcare is severely restricted.

The BARNARDs study was one of the first studies to blend clinical and molecular epidemiology from LMICs to characterize neonatal Gram-negative infections and their AMR profiles, and link this to clinical outcomes and risk factors (including social deprivation, access to clean water, sanitation and hygiene conditions, and antibiotic use).

The first phase of BARNARDS successfully produced a comprehensive microbiological and clinical dataset from (largely) city/large hospitals from 12 different sites, across seven different countries (Bangladesh, Ethiopia, India, Nigeria, Pakistan, Rwanda and South Africa). The second phase of the study will continue surveillance across these countries but expand coverage to rural areas, while also characterizing the neonatal microbiome and the resistome during the first year of life and assessing how this impacts newborn development.

COVID-19/DRI

Impact of COVID-19 on bacterial sepsis, antimicrobial usage and resistance

The COVID-19 pandemic has been predicted to lead to increase usage of high-end antimicrobials, lack of microbiological testing, and alteration of usual clinical and infection control practices, which are likely to increase the burden of AMR.

To better understand the impact of COVID-19 on AMR, we designed an observational cohort study to investigate the changes in the clinical practices with regards to blood culture from the suspected sepsis cases, antimicrobial usage, AMR profiles, antimicrobial stewardship, and infection, prevention, and control (IPC) during the COVID-19 pandemic.

This is a retrospective study, combining de-identified patient data, hospital data and microbiological data on blood and respiratory samples from a global network of hospitals involving 10 countries (Malawi, Bangladesh, India, Nigeria, Brazil, Turkey, UK, Italy, Switzerland and South Korea).

This project is funded by Wellcome Trust.