MICROBIAL TECHNOLOGY
Rapid diagnostics – warts and all: a report on the fight against AMR
In this second report from this year’s British Society for Microbial Technology Annual Microbiology Conference, BSMT Chair Dr Mark Wilks and colleagues look at three further presentations, all of which focus on and illustrate issues related to antimicrobial resistance.
The focus of this second conference report shines a light on antimicrobial resistance (AMR) in a specific pathogen, in rapid diagnostics, and also provides a national overview.
Resistance in sexually transmitted infections Firstly, Dr Michelle Cole, Clinical Scientist at the STI Reference Laboratory, began by
providing an update on AMR surveillance among sexually transmitted pathogens. As rates of infections continue to rise and antimicrobial resistance becomes increasingly common, there is national and international concern in this area. Linking directly back to data from UK diagnostic laboratories, Dr Cole was able to demonstrate the importance of referred Neisseria gonorrhoeae isolates to
national surveillance programmes. Data were presented that showed how rates of resistance have increased over the past 20 years and how this information has been used to inform treatment recommendations. As resistance is shown to increase to a particular antibiotic it can be removed from the prescribing guidance as it becomes clinically less effective. With N. gonorrhoeae, however, this doesn’t necessarily result in a loss of resistance as the selective pressure is removed. Penicillin has not been used routinely to treat since the 1980s yet 14% of recent isolates retain resistance to this antibiotic. More recently, the Gonococcal Resistance to Antimicrobials Surveillance Programme (GRASP) has begun to undertake routine whole-genome sequencing (WGS) of all submitted isolates, as this can be used to provide information determining interrelatedness of different networks of isolates by characterising isolates at a genetic level. As the database expands, this information can then be used to begin to build up a more detailed picture of transmission and proliferation of resistance at a national level.
While ceftriaxone remains the drug of
Neisseria gonorrhoeae: antimicrobial resistance in this microorganism has increased over the past 20 years (Gram staining).
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last resort for N. gonorrhoeae, Dr Cole also presented data which showed that resistance has now been detected in the UK. In many, but not all, cases these isolates have been linked to travel to the Asia-Pacific region, though there has been concern around the extent of undetected transmission within the UK. Around half of all N. gonorrhoeae diagnoses are via nucleic acid amplification techniques and yield no isolates for phenotypic testing. Therefore, it was necessary to undertake a one-off study using RT-PCR aimed at the penA allele responsible for conferring ceftriaxone resistance. This is currently
AUGUST 2024
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