MICROBIAL TECHNOLOGY


talk. Currently, QCMD is focused on two areas: drug resistance and viral metagenomics. It has seen an increase in the number of NGS datasets submitted for assessment of drug resistance. This has led to workflow information being updated, additional files collected, and improvements to analysis processes to identify quality parameters. Next- generation sequencing for viral metagenomics results in vast volumes of output data. In order to support this molecular diagnostic method, QCMD launched a new pilot in 2020 (ongoing), which aims to assess performance of existing metagenomics protocols as currently implemented by participants. Plans include additional EQA schemes for bacterial metagenomics and genotyping.


After this comprehensive overview, delegates were left with a new appreciation of the continued efforts of QCMD to provide a high-quality EQA scheme covering the range and complexity of molecular assays now available.


Antimicrobial stewardship The principles of antimicrobial stewardship could be regarded as well- established within the UK, documented in policy and protocol, and enshrined within the framework of clinical decision- making. Dr Esmita Charani, Research Lead (Practice, Design and Engineering), NIHR Health Protection Research Unit, at Imperial College London, provided a different perspective and delivered a thought-provoking talk which considered antimicrobial prescribing as a complex social process and from an international angle.


Research funding in this area is focused on developing and evaluating technological solutions, and technology will now doubt have a significant role to play. However, when these solutions fail to consider factors, such as end-user requirements or resource availability they will struggle to realise their potential. Dr Charani highlighted the limited research in areas such as implementation and the influence of social contexts in which antimicrobial prescribing occurs. The focus on technological solutions, more likely to be initially employed in high- and middle-income countries, perhaps indicates a disconnect between those areas that carry the burden of antimicrobial resistance and those with the resources to pursue and direct research funding. Even in regions where there are clear policies in place, decision-making can be influenced by a wide range of factors that are difficult to quantify


18


Sequencing using the Oxford Nanopore system.


and assess. Power dynamics in strictly hierarchical institutions can lead to a lack of engagement with wider healthcare professionals such as pharmacists who can contribute key knowledge. Incredibly, there is clear evidence that pharmacist gender still has a quantifiable influence on the acceptance of prescribing advice and stewardship recommendations. The references presented to support these conclusions were drawn from a high-income, technologically developed country suggesting this remains a concern despite the perception of social progress in these areas.


Access to a high-quality diagnostic service was recognised as crucial to guide decision-making. However, the capabilities of laboratories and crucially the confidence in the accuracy and clinical relevance of results produced is critical to these tests positively influencing antimicrobial prescribing. This is an area in which there remains significant variation across different global settings. Managing AMR on the international


stage requires coordination and collaboration between many different groups. Overarching policies are important but consideration must also be given to local interactions, and educating both prescribers and patients/carers is as essential. Dr Charani demonstrated that behind every simple subject lies a more complex reality. More research into the individual social dynamics and socioeconomic inequalities both between and within different regions must be considered to allow effective interventions to have the desired effect.


Looking to the future We hope to return to some of the other topics of the meeting, in particular the use of NGS in microbiology, in a future


article. The BSMT is grateful to all the speakers and to Professor Brian Duerden CBE who chaired the afternoon session in what proved to be a stimulating day of excellent presentations. We were sorry that Dr Kate Templeton, BSMT President, who was due to chair the morning session, was prevented from attending by a cancelled flight from Edinburgh. Cancellation of a different flight from Edinburgh also thwarted Michael Croughan, the BSMT treasurer, who could not get to London for the conference, the first one he has missed in 37 years of the BSMT conferences. It can’t have been easy to cope in


the afternoon session when the air conditioning failed in the extreme heat, despite the best efforts of the museum staff to look after the welfare of everyone who attended. Thanks also to the 20 commercial companies who sponsored the event – more details about these companies and their products relevant to the conference were provided in a recent issue of Pathology in Practice (June, page 42), and details are also on the BSMT website (https://bsmt.org.uk). Watch Pathology in Practice and the BSMT website for more details about the next Annual Microbiology Conference to be held on Thursday 11 May 2023, again at the RAF Museum, Hendon. Alternatively, email Valerie Bevan (vbevan@bsmt.org.uk), who will add your name to the list of people kept informed about the conference by email. Topic to be decided – ideas welcome!


Dr Mark Wilks would like to thank David Westrip, Carolyne Horner, Samantha Manyanga and Valerie Bevan from the BSMT Committee, all of whom contributed to this article.


SEPTEMBER 2022 WWW.PATHOLOGYINPRACTICE.COM


Cirosantilli2 CC BY-SA 4.0 Wikimedia Commons


Page 1  |  Page 2  |  Page 3  |  Page 4  |  Page 5  |  Page 6  |  Page 7  |  Page 8  |  Page 9  |  Page 10  |  Page 11  |  Page 12  |  Page 13  |  Page 14  |  Page 15  |  Page 16  |  Page 17  |  Page 18  |  Page 19  |  Page 20  |  Page 21  |  Page 22  |  Page 23  |  Page 24  |  Page 25  |  Page 26  |  Page 27  |  Page 28  |  Page 29  |  Page 30  |  Page 31  |  Page 32  |  Page 33  |  Page 34  |  Page 35  |  Page 36  |  Page 37  |  Page 38  |  Page 39  |  Page 40  |  Page 41  |  Page 42  |  Page 43  |  Page 44  |  Page 45  |  Page 46  |  Page 47  |  Page 48  |  Page 49  |  Page 50  |  Page 51  |  Page 52  |  Page 53  |  Page 54  |  Page 55  |  Page 56  |  Page 57  |  Page 58  |  Page 59  |  Page 60  |  Page 61  |  Page 62  |  Page 63  |  Page 64