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Resistance to antibiotics is a growing issue worldwide. Mapping where the resistance is as well as its distribution and diversity is hampered by the lack of laboratory facilities in many parts of the world. New technologies allow the characterisation of whole pathogen communities, giving us clues where multi-drug resistant organisms come from. This can help set up a better public health perspective surveillance.

Q: Why do we need to track bacterial antibiotic resistance?

Olga Tosas-Auguet: Resistance to antibiotic is a growing issue worldwide. We know that bacteria are increasingly resistant and this resistance is making it difficult for infections to be treated. To put this into perspective, it has been estimated that by 2050 mortality attributed to resistant infection may be as much as cancer deaths today. In order to tackle antibiotic resistance we first need to understand where the burden is, as well as its distribution and diversity. It is like to put out a fire you first need to be given the co-ordinates of where the fire is and an understanding of how big the fire may be. That is why we need to understand where resistance is, and to track resistance over time.

Q: What are the challenges of working in a resource-limited setting?

OTA: To know how much resistance there is and where it is, national and international agencies collect data. This systematic activity is called surveillance. The most common form of surveillance in the case of bacterial antibiotic resistance is to get samples from hospitals. As an example, a patient will go to hospital, have a urine sample taken that is sent to the lab, analysed and then, nationally and internationally, this data is pooled to give us an understanding of where resistance is. In resource limited settings unfortunately many healthcare facilities, particularly in Africa where we are trying to do some work, don't have operational microbiology labs. Therefore we don't know how much resistance there is and which populations are most affected by not being able to be treated with current antibiotics.

Q: What are the most important lines of research that have developed in the past 5 or 10 years?

OTA: A very important line of research is the ability to characterise the genetic fingerprint of any pathogen, and the fact that sequencing technologies are becoming increasingly affordable. Beyond that, and even more important than that, is the fact that we can now analyse not only a single pathogen at the time but the whole pathogen community in a single sequencing run. What we are trying to do at the moment is to take advantage of these developing technologies and to try and think out of the box as to how we can increase coverage of surveillance in areas that do not have laboratory capacity.

Q: Why does your line of research matter, why should we put money into it?
OTA: Surveillance as it stands now is extremely good at helping clinicians decide which treatment they should be giving their patients and that is absolutely right. Building capacity in that area by building labs across low-resource settings is essential. However, we argue that we also need the 'public health perspective' surveillance methodology. That will not be useful to inform individual patient care, but can inform governments as to what areas have a problem of antibiotic resistance, or where there is a threat of antibiotic resistance, because we can see it from other data sources that are not individual patients, and therefore they should be focusing their resources there. We know that these mapping exercises can be very helpful in informing public health intervention, from studies that we have previously conducted in London. This public health perspective approach has given us clues as to where multi-drug resistant organisms come from, how they are spreading and whether they spread inside the hospitals or outside in the community alone.

Olga Tosas-Auguet

Dr Olga Tosas-Auguet aims to develop ad evaluate a new approach to large scale surveillance of bacterial antibiotic resistance in low income settings. This approach can then be taken forward to a testing stage, initially in partnership with an emerging network of policy makers and healthcare practitioners in Africa.

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