Seminar series

Special seminar on "Intelligent use of Data to tackle antimicrobial resistance" with guest speaker Dr Gwen Knight from LSHTM.

Dr Tim Rawson presented on “Improving decision making during antimicrobial management”.

Antimicrobial resistance is a leading patient safety issue. With the increasing uptake of electronic health records, research has started to focus on methods of optimising the use routinely available data to improve decision making surrounding antimicrobial management. Often packaged within clinical decision support systems, these tools tend to have a narrow focus and experience failures in adoption by end users following implementation. Several recommendations have been made to improve the development and reporting of such tools in the literature. In this seminar, the role of integrated decision support was reviewed including the need for linkage with behaviour change to promote better adoption on implementation by end users.

Our guest speaker from LSHTM, Dr Gwen Knight, presented on “Tackling transmission of antimicrobial resistance using mathematical models”.

Antimicrobial resistance (AMR) is one of the world’s biggest public health concerns. Although many interventions have been suggested, determining which will have the biggest impact is of great importance. One way to compare interventions and hence optimise resource allocation is to predict future AMR burden under different control measures using mathematical modelling. However, these predictions rely on a complex and often hidden parameter: the rate of transmission. In this talk Dr Knight discussed how we can use colonisation pressure as a proxy for transmission, estimate this parameter from clinical data and describe how the complicated natural history of transmission (or fitness) can be teased apart using mathematical models. This will use data on carbapenem resistant Enterobacteriaceae (CRE) from Imperial College Healthcare NHS Trust, as well as data from Peru on multi-drug resistant Mycobacterium tuberculosis transmission.

Timothy Miles Rawson a Clinical Research Fellow at the NIHR Health Protection Research is currently leading EPIC IMPOC, a project aiming at exploring the utility of integrating machine learning techniques, rapid diagnostics, and mechanisms for drug dose optimisation into clinical decision support systems to improve infection management in the hospital setting.

Gwen is an Assistant Professor at LSHTM. She currently holds an MRC Skills Development Fellowship. Her research focuses on using mathematical modelling to target infectious disease spread, in particular the spread of antimicrobial resistance.

Professor Ramon Vilar, "Targeting quadruplex-DNA in promoters of genes associated to antibacterial resistance"

Antimicrobial resistance (AMR) is increasingly being recognised as one of the biggest global health concerns. The inability to treat bacterial infections could lead to an annual death toll of 10 million worldwide by 2050 and make many of the medical advances of the 20th century obsolete. The 3-decade void in antibiotic drug discovery means that recently discovered therapeutic targets have not been fully exploited in this field. An example of a therapeutic target that has so far been under exploited in AMR are the G-quadruplexes, which have been extensively studied in cancer. G-quadruplexes are quadruply-stranded helical structures found in guanine-rich oligonucleotides and are thought to play essential biological roles including regulation of gene expression.

In this seminar Prof Vilar described preliminary investigations aimed at exploring the role that G-quadruplexes may play in regulating the expression of genes responsible for antibiotic resistance in Pseudomonas aeruginosa. The latter is responsible for many life-threatening infections and has been identified as one of three highest priority pathogens in a recent World Health Organisation report. The talk focused on the biophysical characterisation of a series of quadruplex-forming sequences. Prof Vilar showed that some of them form robust G-qudruplexes and they may be potential targets for the development of new small-molecule drugs.

Dr Avinash Shenoy, “Caspase targets in host immunity to infection”

Caspases are cysteine proteases that regulate many aspects of cellular and immune physiology through the actions of their substrates. The contributions of caspases to host-defence will be better understood if we identify and characterise their substrates more comprehensively. Dr Avinash's group identified several new targets of caspases through proteomics, and they are currently characterising their roles during infection.

Professor Jackie Hunter, “AI and Biomedicine: Culture clash or marriage made in heaven”

Jakie Hunter has made major scientific contributions to neuroscience research and development within the pharmaceutical industry and has had a broader impact across industry and academia. She is also a Professor at St George’s Hospital Medical School and was CEO of the Biotechnology and Biological Sciences Research Council.

You can watch Jakie here on "Using AI to gather data for pharmaceutical R&D"

Richard Compton, “Nanopore Sequencing, with a focus on Infectious Diseases”

Richard’s introduction to nanopore sequencing showed us how this technology is designed, allowing the user to digitise a biological sample and stream data for real time analysis with little or no laboratory infrastructure and share the results with other professionals, such as scientists, organisations, or healthcare professionals.

Dr Tim Rawson, "Enhanced, Personalised, and Integrated Care for Infection Management at the Point-of-Care” EPIC IMPOC

Healthcare professionals who diagnose and treat infections must often do so rapidly to prevent harm to their patients.  Their prescribing decisions can be assisted by providing them with access to treatment recommendations, based on the most likely organism causing the infection (antimicrobial guidelines) and data on local antimicrobial resistance patterns.  These decision support systems are mostly rule-based, providing easy-to-access policies or guidelines.

You can learn more about EPIC IMPOC here

Dr Caroline Colijn, “Bacterial Olympics: Competition and resistance”

Bacteria compete all the time: for hosts to infect, for resources within those hosts, against each other in a hostile immune system whose cells can only target so many bacilli at a time. The outcome of these Olympian struggles for survival depends on "fitness", but fitness is complex. One type's success depends on who it's competing with and how much, as well as on the host environment and antimicrobial treatment. These competitions happen over days, but also over decades, both within hosts and at the community and national levels.

Caroline;s group has found how resistance plays out over time depends crucially on how strongly resistant and sensitive variants compete -- for example, if they share a scare resource, they compete more than if the resource is plentiful. Competition can take place at different strengths and in diverse ways, and it can dramatically change how best to manage resistance. While competition is challenging to observe directly, it may be possible to use pathogen genetic data in novel ways to detect it.

Professor Alasdair "Alex" Cook, Head of the Department of Veterinary Epidemiology and Public Health from University of Surrey

A veterinary epidemiologist with more than 25 years of national and international experience Professor Alex Cook interest in epidemiology grew from working in farm animal veterinary practice and in preventive veterinary medicine in the UK and overseas. With a professional life engaged with and leading multi-disciplinary teams makes Alex a natural proponent of the One Health perspective and a promoter of digital innovation in animal health in research, education and business.

Dr Jesus Rodriguez Manzano, "Towards rapid point-of-care diagnostics for infectious diseases and antimicrobial resistance."

Antibiotics have saved millions of lives, decreasing mortality associated with minor infections, injuries and childbirth, as well as preventing disease outbreaks from escalating to pandemic levels. However, the increasingly liberal use and misuse of antibiotics has led to a global health crisis: the widespread development of antimicrobial resistance. In order to provide correct, life-saving treatment and to facilitate antibiotic stewardship it is critical to have a rapid and reliable test for pathogen’s susceptibility to the available drugs.

Because most antibiotics are prescribed outside of tertiary hospital settings without an immediate access to a clinical lab—physician offices, emergency rooms, urgent care clinics—antibiotic therapy and stewardship critically depend on a distributed antibiotic susceptibility test that can be performed rapidly at the point of care.

Dr Nick Voulvoulis, “Antibiotics in the environment, implications for Antibiotic-Resistance”

The environmental pathways that result in an increased risk associated with antibiotic-resistant bacteria are multiple and complex. Antibiotics can enter the environment in many ways, from production, through the excretion of residues after usage (households and hospitals), through discarding unused medicines, or farming practices as a result of animal use.

Dr Voulvoulis group has investigated two of these routes:  via the effluent from wastewater treatment works (WWTWs) after excretion from the body, and by the disposal of out-of-date or unwanted medicines, which may occur via the sink/toilet or in household waste. Findings showed nearly 80% of people consuming all of the painkillers that they buy or are prescribed, whereas the figure for antibiotics (18%) was worryingly low. Household waste was the most popular disposal method for all types of drugs.

Dr Voulvoulis group also looked at pharmaceutical waste as a problem for the National Health Service (NHS); and investigated the potential of medicine reuse schemes. This led to the development of a framework to enable authorities responsible for hospital management to evaluate risks associated with pharmaceuticals in wastewater effluents and solid waste.

Prof Ramesh Wigneshweraraj, "Phage-inspired solutions to combat antibacterial resistance?"

Dr Nickolas Croucher, "The emergence, spread and loss of antibiotic resistance in pneumococci"

Dr Elita Jauneikaite, "Using whole genome sequencing to investigate healthcare-associated infections and antimicrobial resistance"

Dr Enrique Castro-Sanchez, "Do Android (phones) dream of health games and apps? Exploring e/g-health interventions in patient safety"

Dr Gabriel Birgand, "Measures to control the spread of Multi-drug resistant organisms in hospitals: what are the current problematics?"