MICROBIAL TECHNOLOGY
It’s sobering to reflect that in spite of all the increasingly sophisticated and expensive technology, the majority of the world’s population does not have access to even the most basic laboratory services
approaches to STI AMR surveillance. Neisseria gonorrhoeae Sequence Typing for Antimicrobial Resistance (NG-STAR) is a MLST scheme specifically developed for N. gonorrhoeae sequence typing and the identification of specific antimicrobial resistance determinants, thus allowing phenotypic antimicrobial susceptibility to be inferred from some alleles and sequences types (STs). The variety of NG-STAR types identified thus far should be able to show whether DGIs are caused by a single virulent clone or are related to the problem of delayed diagnosis as mentioned above, in which case we could expect to see a variety of NG-STAR types. Dr Cole’s work has also involved Mycoplasma genitalium, which can cause non-gonococcal urethritis in men and is associated with cervicitis and pelvic inflammatory disease in women. The sexually transmitted bacterial pathogen M. genitalium has proved a complex organism to work with in the laboratory setting. Owing to its extremely fastidious nature, successful growth of M. genitalium in the laboratory has proved elusive, particularly in the UK which has arguably lagged behind other countries in realising the importance of this organism. Antimicrobial resistance to both first- and second-line recommended therapies (macrolides and fluoroquinolones, respectively) is commonly reported. However, phenotypic susceptibility testing is not routinely performed because culture is so rare. Instead, molecular detection of known resistance determinants is used to infer susceptibility
or resistance. As with N. gonorrhoeae, future treatment options are extremely limited for M. genitalium and, if this sexually transmitted infection is to remain treatable, phenotypic susceptibility testing will have a role in evaluation of potential therapeutics. Furthermore, molecular assays are of limited use for detection of emerging resistance mechanisms, as by definition the target is unknown. As such, the ability to introduce and retain culture retainment of these techniques in at least some laboratories is important. Antimicrobial resistance in
M. genitalium is presently a minor public health concern and not nearly as important as that of N. gonorrhoeae and DGI; however, surveillance remains very limited. Dr Cole has been involved in the development of a protocol for routine national surveillance of AMR in M. genitalium in England (MARS). The MARS protocol aims to estimate the prevalence of macrolide and fluoroquinolone resistance in M. genitalium infections among adults (≥18 years) attending sentinel sexual health services (SHSs) in England, and characterise factors associated with resistance.
A final sobering reflection Lastly, Ivor Mitchelmore, now-retired chief biomedical scientist, Luton & Dunstable University Hospital, will describe his work in setting up a microbiology service in a low- to middle-income country from scratch. It’s sobering to reflect that in spite of all the increasingly sophisticated and
expensive technology described above, the majority of the world’s population does not have access to even the most basic laboratory services and the kind of work that Ivor will describe; for example, introducing a basic blood culture set-up and sensitivity testing can be transformative and achieved at a very low cost.
References 1 Neale D, Cullen L. Evaluating the National
Action Plan (NAP) on antimicrobial resistance, and recommendations for the next 5-year NAP: a roundtable discussion. Sustainable Microbiology 2024 Jan; 1 (1): qvad001.
https://doi.org/10.1093/ sumbio/qvad001.
2 Wilks M. Rapid diagnostics – warts and all: a microbiology conference preview. Pathology in Practice 2024 Feb; 25 (1): 14–6.
3 The Guardian. Hospital admissions for easily treatable STIs rise amid funding cuts in England. 16 Feb 2024 (https://www.
theguardian.com/society/2024/feb/16/ hospital-admissions-for-sexual-health- conditions-rise-amid-funding-cuts-in- england).
As in previous years, the BSMT conference will have a full trade show supported by 12 of the most innovative companies attending to present the latest developments and newest equipment to talk to delegates about what their companies can offer laboratories. The conference provides scientists with the opportunity to discuss and debate their experiences: and a great chance to question the experts! This year the number of talks has been reduced to six, rather than seven, to allow more time for delegates to ask questions and make comments. Registration is now open, and early booking is advised as the conference last year sold out. Please check the BSMT website to register and for any updates to the programme.
www.bsmt.org.uk
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