Cookies on this website

We use cookies to ensure that we give you the best experience on our website. If you click 'Accept all cookies' we'll assume that you are happy to receive all cookies and you won't see this message again. If you click 'Reject all non-essential cookies' only necessary cookies providing core functionality such as security, network management, and accessibility will be enabled. Click 'Find out more' for information on how to change your cookie settings.

Antibiotic resistance is one of today's major global health problems. Mathematical models help us answer what if questions and evaluate the impact of specific interventions such as hands hygiene on the spread of bacterial drug resistance. Effective solutions are then translated into policy changes or changes in practice at national or international level.

Ben Cooper: Drug resistance in bacteria is one of the major global health problems that we're facing now. Increasingly, bacteria that cause serious infections are becoming resistant to the antibiotics that we use. And this is particularly a problem in South East and South Asia, particularly in lower and middle income countries. In some cases we are already seeing infections which can't be treated with the antibiotics available in those countries. The risk is that resistance will continue to spread more and more and that we'll see more commonly infections which we don't have antibiotics to treat them with.

The great thing when you have a mathematical model is that you can start to ask what if questions: What if we increase hands hygiene by 20%? What impact would that have on how the bacterial infections spread? How many infections will the patients get? As we get better and more reliable mathematical models - so we need to fit these models to data - we can increasingly ask what would be the impact of changing the way we use antibiotics on how much resistance we see.

We recently published a paper that analysed data from all the highest quality hands hygiene intervention studies and found good evidence that this intervention can significantly improve hands hygiene, and that appears to be associated with reductions in infections with certain drug-resistant bacteria. We have also used mathematical models to show how increases in hands hygiene can be associated with substantial reductions in certain resistant infections, and recently how this can be a very cost effective intervention. This kind of work feeds into policy decisions made by governments to invest in hands hygiene campaigns. That has happened already in previous work in Europe and we're hoping it's going to happen increasingly in lower and middle income countries.

Similarly, I have done some work on pandemic influenza, and using mathematical models to look at how movement restrictions - whether shutting down airports, stopping people traveling - would impact on the spread of pandemic flu. And we found, surprisingly, that it would have very little impact. And that also fed into international recommendations on how to respond to a pandemic.

Q: What important lines of research have emerged in the past few years?

BC: One of the biggest changes in the last few years is the emergence of very cheap sequencing technology. It used to be incredibly expensive and hugely time consuming to look at the DNA sequence of a particular bacteria. It costs now about $100 to get the whole genome sequence of a bacteria. This means we can get very detailed information on the DNA of a bacteria, which we can use as a kind of bar code, and we can use that bar code to identify how these bacteria are spreading between patients. This has potentially a huge impact on how we can understand how bacteria are spreading between individuals.

Q: Why does your research matter?

BC: The research into antibiotic resistance bacteria matters because antibiotics are incredibly useful. They have had a major impact on human health since they were introduced. The threat of antibiotic resistance risks putting us back into the pre-antibiotic era. We're already seeing that in some cases when patients have infections antibiotics are not available to treat them. The risk is that this can happen more and more. So we really need to find strategies to combat the spread of resistance.

Q: What is the impact of your research on patients? How does it fit into translational medicine within the Department?

BC: The first aspect of our work is to understand what is going on, how bacteria are spreading. The second aspect is to find what interventions work to stop this resistance spreading and to improve patient outcomes. The third aspect, when we have found effective solutions, is to try and translate them into changes in policy or changes in practice at a national or international level.

One aspect of our work that I think helps a lot is when we combine analyses with cost effectiveness, because we can show not only if a certain intervention works and is likely to improve patient outcomes, we also show it is worth governments investing in- it is actually something they should be doing.

Ben Cooper

Professor Ben Cooper from MORU in Thailand uses mathematical modelling and statistical techniques to help understand the dynamics of infectious disease and evaluate potential control measures.
The major focus of this work is on antibiotic-resistant bacteria that cause common infections (e.g. urinary tract infections, pneumonia, bloodstream infections) in resource-limited hospital settings.

More podcasts related to Global Health

Mike English: Health services that deliver for newborns

Basic hospital care may be key to saving newborn lives. Professor Mike English outlines a multidisciplinary project engaging policy-makers and practitioners in Kenya. This project demonstrated poor coverage of Nairobi’s 4.25 million population if a sick newborn baby needs quality hospital care. Using novel research approaches the team also identified how severe shortages of nurses contribute to poor quality of care for patients and negatively affect nurses themselves.

Tran Hien: Infectious diseases in the tropics

Although incidence of malaria has decreased in Vietnam, the burden of infectious diseases remains high and weighs heavily on the health care system. Clinical research aims to allow investments to go further: findings in the laboratory, tested in clinical trials and then applied to the community, help improve diagnosis and management.

Ronald Geskus: Sophisticated biostatistics for complex clinical research

The role of biostatisticians in clinical research is to contribute to trial design, by calculating sample size for example, and to help draw correct conclusions from the data, discriminating important information from noise. They are instrumental in the translation of a practical problem into a statistical model, and the translation of the result into practice.

Rogier Van Doorn: Research at OUCRU Hanoi

Antibiotics are widely used in Vietnam, leading to widespread antimicrobial resistance. Monitoring antibiotic use helps inform the government to change treatment guidelines and implement antibiotic stewardship programmes. This may also prevent the transmission of resistant bacteria outside the country.

Heiman Wertheim: Clinical research in low and middle-income countries

Drug resistant infections are a global crisis and we cannot focus on our own country only. Clinical trials in low and middle income countries where the burden is highest, as well as work with local communities and engagement with policy makers help influence public health policies.

Guy Thwaites: Tuberculosis meningitis

Tuberculosis meningitis affects a fractions of TB patients but causes high levels of mortality and morbidity. A recent trial at OUCRU showed that aspirin can greatly improve outcomes. Such trial is typical of the work done in our Vietnam units, where all the research is focussed on improving the outcome for patients directly.

Motiur Rahman: OUCRU laboratory management

OUCRU laboratories provide support to the unit’s extensive clinical research programme, from level 2 laboratory to SAPO 4 laboratory for high-risk pathogens responsible for zoonotic infections. Early diagnosis and detection of antimicrobial resistance helps prescribe the right medicine in time, contributing to better patient management.

Raph Hamers: Developing collaborative clinical trials in Indonesia

Indonesia is a very populous country with a huge burden of infectious diseases such as TB, malaria, HIV and CNS infections. Running clinical trials requires high levels of expertise, currently developed and strengthened by institutions such as IOCRL (Universities of Indonesia and Oxford Clinical Research laboratory). Better collaborations will also help great ideas make a bigger impact.

Jeremy Day: Central nervous system and HIV infections in Vietnam

Brain infections such as meningitis and encephalitis are highly debilitating diseases, and an accurate diagnostic is essential to give patients the best treatment available. For cryptococcal meningitis, clinical trials focus on prevention, for an early diagnosis, and novel ways to use existing treatments or repurpose old drugs.

Abhilasha Karkey: Connecting research with communities in Nepal

Antimicrobial resistance is a huge burden in Nepal, particularly in hospitals where many nosocomial infections are caused by resistant pathogens. With limited resources, little infection controls and proper guidelines in place, finding out the main risk factors helps reduce infection rates within a hospital and better target vaccination campaigns.

Translational Medicine

From Bench to Bedside

Ultimately, medical research must translate into improved treatments for patients. At the Nuffield Department of Medicine, our researchers collaborate to develop better health care, improved quality of life, and enhanced preventative measures for all patients. Our findings in the laboratory are translated into changes in clinical practice, from bench to bedside.