Tackling Antimicrobial Resistance: An Interdisciplinary Approach

点击翻译按钮获取中文摘要

The proposal aims to facilitate and encourage multidisciplinary research at Loughborough University (LU) into the healthcare environment (air, water and surfaces) and in community settings (e.g. nursing and care homes, low income countries with high population densities) as potential reservoirs for the transmission of antimicrobial resistant infectious agents. Hospital surfaces are a reservoir for transmission of antimicrobial resistant infectious agents, typically via contamination of the hands of healthcare workers. Staphylococci, C. difficile and Acinetobacter species have been shown to survive many months on high touch near-patient surfaces in healthcare environments. Recent epidemiological evidence suggests that patients admitted to rooms previously occupied by colonised patients have a higher probability of acquiring (i.e. is a risk factor for colonisation or infection) the same pathogen. Other studies have shown aerial dissemination of infectious agents, e.g. C. difficile spores, making it particularly difficult to eradicate infectious agents in hospitals. Despite a recent focus on performance management to improve the efficacy of cleaning and disinfection processes, published studies have demonstrated the presence of culturable indicator organisms (e.g. Methicillin-resistant Staphylococcus aureus and Vancomycin-resistant enterococci) post conventional "terminal disinfection" (i.e. upon patient discharge). Bacterial endospores (e.g. Clostridium difficile) are particularly resilient to routine disinfection treatments due to a variety of factors including use of insufficient, low concentration disinfectant, inadequate contact times etc .The Chief Medical Officer's report highlights issues such as poor design that limits cleaning, poor ventilation and poor water-supply management (risk of Legionella species and Pseudomonas aeruginosa). One of the problems of AMR is the length of time taken to identify pathogens (1-3 days) resulting in (i) potential spread of infectious agents; (ii) antibiotics given to patients unnecessarily 'just in case'. Rapid diagnostics would aid early detection and isolation of patients that would otherwise spread contamination. Photocatalytic self-cleaning surfaces could inactivate infectious agents landing on surfaces thereby breaking the link between contaminated surfaces and transmission through contact. Barriers and levers could be identified to improve hand-hygiene compliance whilst monitoring compliance in real-time using teletracking technology. Novel surface, air and water disinfection systems could be developed e.g. using atmospheric plasma technology. Natural ventilation systems could be designed to improve air quality and reduce dispersal of infectious agents in multi-bed wards. The proposal aims to focus on the following three AMR research themes: (i) Accelerating therapeutic and diagnostics development - Alternative approaches to treat resistant bacteria; New technologies for identifying resistant bacteria to underpin diagnostics development; Scale-up and manufacture of biotherapeutics; The effective delivery of existing antimicrobial agents (ii) Understanding the real world interactions - Understanding the role of the environment as a reservoir for AMR microorganisms and the transmission of infections in community and healthcare environments; Ways to manipulate the environment to prevent transmission (iii) Behaviour within and beyond the healthcare setting - Elucidate underpinning motivations for human behaviours relating to the spread of AMR infectious microorganisms in the healthcare environment and the community; Evaluate interventions to control/prevent the spread of resistant bacteria.