MICROBIAL TECHNOLOGY
Dr Nathaniel Storey from the Department of Bioinformatics, Great Ormond Street Hospital, London.
as directed, poor hygiene and lack of infection prevention and control, and the movement of people (and possibly goods) around the world. Preventing infection in the first instance is key to the management of AMR, emphasising the need for clean water, sanitation, access to immunisation, and good hand hygiene. Other approaches include improving anti- infective use to slow the development of resistance and stopping or limiting the spread of resistance when it occurs. Underpinning these key AMR management strategies are market interventions; legislation, including device and drug regulation; infection prevention, education and motivation, and innovation in areas of digital health, non-traditional therapies, and new diagnostics. There is no shortage of development activity in the field of new therapeutics, with a recent review describing over 400 projects from 300 different institutions currently ongoing. In brief, the majority (46%) of new therapeutic approaches investigated direct-acting small molecules, 70% of which were completely novel and 50% were targeting Gram-negative bacteria. Other major areas of development include projects in antibodies and vaccines (14%), bacteriophages and microbiota modulators (13%);
Dr Mandy Wooton, Scientific Lead at The Specialist Antimicrobial Chemotherapy Unit, Public Health Wales Cardiff.
anti-virulence approaches (8%), and potentiators (8%, mainly β-lactamase inhibitors). Development in the pre- clinical antibacterial pipeline is healthy and needs to be coupled alongside the development and deployment of sustainable rapid diagnostics.
Surveillance support programmes
Low- and middle-income countries (LMICs) suffer disproportionately from antimicrobial resistance due to limited healthcare provision, antimicrobials used in lieu of access to healthcare, and lack of access to second/third-line drugs. In these countries, multi-drug resistance may not necessarily be the main problem, rather resistance to the most widely used/available drugs. Dr Claire Gordon, Consultant in Infection, Rare and Imported Pathogens Laboratory, UKHSA, described one initiative supporting laboratory development for AMR surveillance in LMICs. The Fleming Fund provides £265 m UK aid to support LMICs to generate, share and use AMR data as part of global efforts to understand and reduce the impact of drug resistant infections. Managed by the UK Department of Health and Social Care, in partnership with Mott MacDonald, the programme works in 24 priority countries across Africa and Asia. The vision of the programme
is for clinical laboratories to complete basic bacteriology, and data that are generated are reported to centralised AMR coordinating committees that report to relevant ministries. In recent decades, matrix-assisted laser desorption/ionisation-time of flight (MALDI-ToF) spectrometry has revolutionised microbiological identification in high-income countries. By applying the concept of ‘leapfrog’ technology, defined as bypassing the introduction of traditional methodologies to jump directly to the latest technologies, the current programme aimed to introduce MALDI-ToF into LMIC laboratories that have had minimal acess to culture methods because of limited resources. Aside from rapid and accurate identification, compared with traditional biochemical identification methods, MALDI-ToF requires little additional consumables and reagents, solving supply chain issues. Nor does it produce much waste, with little environmental impact, and doesn’t require specialist skills or training. In terms of cost, based on current estimated instrument lifetime of seven years, capital outlay will be recouped if sample throughput is maintained at 5000 isolates / year, with a cost similar to that of standard processing using traditional identification methods. Additional samples cost $3.81 for identification,
There is no shortage of development activity in the field of new therapeutics, with a recent review describing over 400 projects from 300 different institutions currently ongoing. In brief, the majority (46%) of new therapeutic approaches investigated direct-acting small molecules, 70% of which were completely novel and 50% were targeting Gram-negative bacteria
18 JUNE 2023
WWW.PATHOLOGYINPRACTICE.COM
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