The role of PHE s AMRHAI Reference Unit

Transcription

1 The role of PHE s AMRHAI Reference Unit Professor Neil Woodford Antimicrobial Resistance & Healthcare Associated Infections (AMRHAI) Reference Unit Crown copyright

2 What does AMRHAI offer? Susceptibility testing for confirmation of exceptional resistances Infer resistance mechanisms from antibiograms Investigation of priority resistance mechanisms Strain typing to aid outbreak investigation Treatment advice; infection prevention & control advice + Research (externally-funded) + Evaluations of new drugs and diagnostics (externally-funded) 2 UK-Russia (Moscow), 18th December 2015 Crown Copyright

3 My Unit s goals Setting England s (the UK s) Resistance and HCAI Problems into National and Global Context Better understanding of (resistant) bacterial clones distribution (global, national, regional) contribution resistance plays to success Coordinated surveillance of mechanisms global, regional and national Identify geographic hot spots and high risk patients early, targeted IPC interventions 3 UK-Russia (Moscow), 18th December 2015 Crown Copyright

4 Feed into the UK s integrated surveillance of AMR risks Colonized residents or visitors Non-human reservoirs: foodstuffs (domestic or imported) Non-human reservoirs: animals and environment Hospital treatment or travel overseas Inter-hospital transfers (UK) Victims from conflict zones Multiple risks to be assessed to minimize damage We need better intelligence 4 UK-Russia (Moscow), 18th December 2015 Crown Copyright

5 AMRHAI works with PHE s surveillance scientists Pathogen % carbapenem resistance E. coli K. pneumoniae Provides specialist microbiology that seeks to explain trends Is at the centre of a national / regional laboratory network Benefits from a spider s web effect Monitors new and emerging AMR issues, long before they register in surveillance programmes 5 UK-Russia (Moscow), 18th December 2015 Crown Copyright Data, courtesy Prof Alan Johnson

6 CPE in the UK, Imported & home grown Early cases often imported Klebsiella spp. 79%; E. coli 12%, Enterobacter spp., 7%; others 2% 6 UK-Russia (Moscow), 18th December 2015 Crown Copyright AMRHAI, Unpublished data

7 Towards WGS for reference services Define lineage & surveillance Predict resistance Biomarkers ID + Outbreak investigations Phase 2 WGS Assess virulence 7 UK-Russia (Moscow), 18th December 2015 Crown Copyright

8 WGS-based genotypic antibiograms could soon replace much AST for surveillance purposes low impact of the low error rate could soon reduce need for AST in reference laboratories unless to guide treatment for agents with poorest genotypic/phenotypic concordance comparative in-vitro activity of new agents EUCAST Subcommittee on the role of whole genome sequencing (WGS) in antimicrobial susceptibility testing of bacteria Chair: Neil Woodford, London UK; will report in mid UK-Russia (Moscow), 18th December 2015 Crown Copyright

9 Working with academia Health Protection Research Units in HCAI and AMR Imperial College and PHE (Alison Holmes and Alan Johnson) University of Oxford and PHE (Derrick Crook and Neil Woodford) National research units involving a network of relevant, world class expertise that can comprehensively address the challenges of AMR and HCAI, with the resilience and capacity to respond to emerging issues and public health priorities Creating integrated programmes of research to develop new, cost-effective approaches for detection, surveillance, investigation and reduction of HCAI and AMR in the NHS 9 UK-Russia (Moscow), 18th December 2015 Crown Copyright

10 Working with industry extensive collections of MDR clinical isolates Active vs. >90% UK CPE independent evaluations of: diagnostics AST platforms developmental antibiotics Possible No 2 0 Approved Phase 3 Phase 2 Phase 1 10 UK-Russia (Moscow), 18th December 2015 Crown Copyright

11 AMRHAI is a WHO Collaborating Centre Participate in missions and training courses AMR and/or IPC Promote reference microbiology for AMR Reference testing and characterisation of isolates received Supply control isolates Promote research/development in reference laboratories Host overseas visitors on short or long-term placements Support applications for funding Seek funding for WHO CC activities Lobbying Groundwork for bids to The Fleming Fund in UK-Russia (Moscow), 18th December 2015 Crown Copyright

12 Improving interaction with other AMR CCs CAESAR Network one-year FTC post (lab-based) secured from PHE s AMR Priority Programme Delivery Board, to support projects Seek close working with CCs at RIVM and in Smolensk bid to Gates Foundation (Karolinska / PHE / RIVM) WHO-Net close working with CC in Boston; named collaborators on bid to NIH develop the software to increase capacity for handling molecular and WGSderived data 12 UK-Russia (Moscow), 18th December 2015 Crown Copyright

13 National & international capacity building Without lab testing we re blind to (the extent of) AMR problems Improve lab access; aim for a reference lab in every country / region Each serving as the hub of a national network Each acting as a spoke in an international network Performing essential techniques, proficient to international standards Sharing data / experience 13 UK-Russia (Moscow), 18th December 2015 Crown Copyright