The evolutionary emergence of multidrug resistant bacterial pathogens

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Who will benefit and how?
This is fundamental blue-skies research but results from this programme of research, and its practical application in clinical and environmental management of antibiotic use, has the potential to deliver far-reaching benefits across a wide range of sectors, from individuals and organizations, to societal benefits from long-term potential gains in the overall lifespan of existing and new antibiotics. The mechanistic understanding of the evolution of antibiotic resistance gained from this project will enable informed clinical decisions of antibiotic use, potential biomarkers of high-risk emerging pathogenic strains, and improved advice to the veterinary and farming community on the use of antibiotics. Although banned now in the EU, use of antibiotics as growth promoters is still widespread elsewhere - up to 40% of antibiotics used are as livestock growth promoters. The beneficiaries of this project can be divided in to 2 groups:
1) General Public: AMR is high on the news agenda, with recent reports of colistin resistance bacteria in China widely reported in the UK and beyond. Despite this, in August 2015, a report from NICE (National Institute for Health and Care Excellence) claimed that 10 million doses of antibiotics are inappropriately prescribed in the UK each year. We envisage that one key strand of impact activities associated with our project will be directed towards improving public understanding of the impending societal crisis surrounding rising antimicrobial resistance. There exists widespread misunderstanding of antimicrobial resistance (AMR) among the general public as shown by recent Wellcome Trust research ("Exploring the consumer perspective on antimicrobial resistance" report). The report identifies 3 key challenges:

1. Public attitudes to antibiotics and treatment are a barrier to improving antibiotic stewardship.
2. Poor knowledge of how antibiotics work and what resistance means lead to misconceptions about the nature of the AMR problem.
3. "Doomsday" scenarios and the huge numbers surrounding the AMR crisis in the media make individuals feel powerless to effect change.

Public engagement events designed to reach different age groups in schools and the wider community will raise awareness of the science underpinning the evolution of antibiotic resistance, and what we can all do to minimise the risk. We will leverage the high-profile of Antibiotic Action, based at UoB, to promote the events and key findings among the general public.

2) Government, Clinical, Agriculture and Veterinary Policymakers: AMR is also high on the policy agenda, with antibiotics of last resort increasingly at risk. Many reports across all these areas are highlighting AMR as a concern, yet there is a dearth of knowledge about the evolutionary mechanisms of AMR emergence particularly in pathogens affecting both humans and animals and where AMR arises through horizontal gene transfer. Our findings will be communicated to key stakeholders that can impact the use of antibiotics and their dissemination in clinical and agri-food environments, including: medical professionals, veterinarians, farmers and the agri-food industry.