Tackling Antimicrobial Resistance: An Interdisciplinary Approach

该建议旨在促进和鼓励拉夫堡大学(LU)对医疗保健环境(空气、水和地表)和社区环境(例如护理和疗养院、人口密度高的低收入国家)进行的多学科研究，作为传播具有抗菌素耐药性的传染病的潜在宿主。医院表面是抗菌素耐药性感染剂传播的蓄水池，通常是通过污染医护人员的手。葡萄球菌、艰难梭菌和不动杆菌已被证明可以在医疗环境中高接触的患者表面上存活数月。最近的流行病学证据表明，住进以前被殖民患者占据的房间的患者感染相同病原体的可能性更高(即，这是殖民或感染的风险因素)。其他研究表明，艰难梭菌孢子等感染性物质在空中传播，使得在医院根除感染性物质特别困难。尽管最近注重绩效管理以提高清洁和消毒过程的效率，但已发表的研究表明，在传统的“末期消毒”(即病人出院时)后，存在可培养的指示性微生物(例如耐甲氧西林金黄色葡萄球菌和抗万古霉素肠球菌)。细菌内孢子(如艰难梭菌)对常规消毒处理特别敏感，原因包括使用不充分、低浓度的消毒剂、接触时间不足等。首席医疗官的报告强调了一些问题，如限制清洁的糟糕设计、通风不良和供水管理不善(军团菌和铜绿假单胞菌的风险)。AMR的问题之一是识别病原体所需的时间(1-3天)，导致(1)传染病的潜在传播；(2)给病人不必要的“以防万一”的抗生素。快速诊断将有助于及早发现和隔离患者，否则会传播污染。光催化自清洁表面可以灭活落在表面上的传染病，从而打破受污染表面和通过接触传播之间的联系。可以确定障碍和杠杆，以改善手卫生合规性，同时使用TeleTrack技术实时监控合规性。可以开发新的表面、空气和水消毒系统，例如使用大气等离子体技术。可以设计自然通风系统，以改善空气质量，减少传染病在多病床病房中的传播。该提案旨在侧重于以下三个AMR研究主题：(1)加速治疗和诊断开发--治疗耐药细菌的替代方法；识别耐药细菌以支持诊断开发的新技术；生物疗法的扩大和制造；现有抗菌剂的有效交付(2)了解现实世界的相互作用--了解环境作为AMR微生物的储存库的作用以及感染在社区和医疗保健环境中的传播；(3)如何操纵环境以防止传播；(3)医疗保健环境内外的行为--阐明与AMR感染微生物在医疗保健环境和社区中传播有关的人类行为的基础动机；评估控制/防止耐药细菌传播的干预措施。

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.