Perceptions of antimicrobial resistance by international travellers.

With increasing global rates of antimicrobial resistance (AMR), the risk of an 'end to modern medicine' (Chan: 2012)1 looms large on the horizon. Antimicrobial resistance will place a huge strain on existing public health structures, locally, regionally and globally in dealing with the severe and protracted illnesses associated with resistant pathogens.

With no new antimicrobial products available, greater emphasis is now being paid to human use of these pharmaceutical products to ensure future usage and continued efficacy. A number of strains of proteobacteria and entereobacteriacea have been shown to be resistant to first and second line antibiotics, and, more worryingly resistant to drugs of last resort (DoLR), rendering these infections as untreatable. Extensive drug resistance has also been identified in other serious infections such as Mycobacterium tuberculosis, Human Immunodeficiency Virus and Plasmodium (Malaria), emphasising the diverse challenge facing humanity. Resistant infections are spreading across the world, facilitated by international travel. Infections no longer remain confined to one corner of the world, through rapid and continuous human exchanges, the threat of antimicrobial resistance faces everybody, everywhere. This project will research trends of international travel associated with AMR, utilising a grounded theory approach that is both sensitive and reflexive to the research data that will allow space for development of new conceptualisations in understanding AM . No known project has been undertaken utilising this approach.

This project will provide new insights into addressing this emerging global threat. Semi structured one-to-one interviews will provide the backbone to this project. Research aims will address health related risk of international travel, abstractions of AMR, infection prevention and infection control decision making and praxis and pre and post exposure infection prophylaxis. Participants will be actively recruited from vaccination and medical centres in England, with a focus on those individuals travelling to high-risk low and middle income countries (utilising the most current WHO antimicrobial resistance report) where emergence and transfer of resistance infections has been established. Trends in AMR will also be monitored according to the World Health Organisation's (WHO) active AMR framework 'GLASS' (Global Antimicrobial Resistance Surveillance Systems) and the European Antimicrobial Resistance Surveillance Network (EARS-Net) to capture a real-time perspective on active threats in addition to Pro-MED (program for monitoring emerging diseases). A literature included in this project will be undertaken to help situate the research into current social and natural science literature.

The project will be of benefit to a broad range of academic disciplines and beneficiaries such as the Public Health England, the European Union, WHO, The United Nations, multilateral, bilateral and governmental public health institutions, international development agencies, non-governmental health actors, and the general public.

1 Chan, M. (2012). Antimicrobial Resistance in the European Union and the World. http://www.who.int/dg/speeches/2012/amr_20120314/en/