Warning over "catastrophic threat" of superbugs

Imperial researchers respond to Chief Medical Officer's report highlighting antibiotic-resistant infections.

Medical experts at Imperial College London have echoed the call from England’s Chief Medical Officer for urgent action to address the “catastrophic threat” posed by antibiotic-resistant infections.

In her first annual report, Dame Sally Davies warned that unless we restrict the use of antibiotics and develop new ones, routine infections could become untreatable within 20 years.

Professor Alison Holmes, Co-Director of the Centre for Infection Prevention and Management (CIPM) at Imperial College London and Director of Infection Prevention and Control for the Imperial Academic Health Sciences Centre, said:

Professor Alison Holmes

“We welcome the CMO’s report and the commitment that it represents. Antibiotic resistance is a matter of national and international biosecurity.

“As well as addressing the need to produce new antibiotics, incentivise drug development, and carry out research into mechanisms to tackle resistance and develop rapid diagnostic tests, we must also address antimicrobial resistance with broader interventions beyond the laboratory.

“AMR also needs to be considered as a major public health challenge within healthcare itself. We have to optimise prescribing to maximise benefit but minimise the risk of unnecessary exposure, and the collateral damage associated with it, for the individual and for society. Transmission of highly resistant organisms must also be minimised through effective infection control strategies.

“Behavioural and organisational factors must be considered, with greater engagement of all those involved in healthcare. Education and the production of policies is not enough on its own. We have to harness the opportunities presented by improved surveillance, qualitative research and the better use of technology. A clearer understanding of behavioural factors that affect prescribing is needed for effective change, reinforced with strong societal messages.

“At Imperial, we’ve been committed to tackling this problem through a variety of innovative approaches for several years, from basic science to behavioural change and using data to support surveillance. This work is in collaboration with Imperial College Healthcare NHS Trust and the Health Protection Agency.

"At the Centre for Infection Prevention and Management, funded by UKCRC, we’re working with our colleagues in the Imperial College Business School to consider behavioural and organisational factors that affect antibiotic prescribing and infection prevention. We’re looking at the role of technology, from rapid diagnostics to smartphone applications, and we’re working with colleagues in the Faculty of Engineering on case-based reasoning to assist antibiotic prescription decisions. On the education side, we run the only Master’s programme in the UK in Infection Management for Pharmacists.”

Professor David Holden, Director of the MRC Centre for Molecular Bacteriology and Infection at Imperial, is optimistic that research into molecular mechanisms of infection will enable scientists to avert the catastrophic scenario described in the CMO’s report.

Professor David Holden

“In the past, the drug pipeline has mainly been driven by empirical approaches, by screening for products that interfere with bacterial growth,” he said. “There are undoubtedly many different natural antibiotics still waiting to be discovered, but many pharmaceutical companies seem to have given up. We need to come up with new ways to find these compounds. At the same time, as a result of recent advances in genetics, biochemistry and cell biology, we are gaining remarkable insights into how bugs cause disease.

“At the CMBI, we have a unique group of individuals who focus on the molecular mechanisms by which bacteria cause disease and how the host immune system works to counteract infections. Along with other scientists working in this area, we hope that the knowledge we gain can be harnessed in the rational design of new vaccines and antibiotics. I think it’s very likely that in the next few years, we’ll see this research bear fruit.”

Professor Sunil Shaunak is collaborating with Dr David Brown at the Babraham Research Campus on a radical new approach to combating bacterial infections, which targets human immune responses rather than the bacteria themselves.

Professor Sunil Shaunak

“There have been no new classes of antibiotics in the last 25 years,” he says. “We have a discovery void. We’re continuing to turn this handle but nothing is coming out.

“We have to accept that we need to apply more than one approach. Killing bacteria is no longer enough on it own. We’re working on the basis that there will be no new Eureka moment for antibiotics in the next 10 years, so we need to move on from attacking bacteria to enhancing the hosts’ ability to protect themselves against invasion.

“It won’t be easy but we don’t have any other choice. At the moment, 10 per cent of deaths in the UK are from infections. In the doomsday scenario that Sally Davies described, we could have one third of patients dying from infections. We’ll be back to the dark ages.”