Dr Gwenan Knight, Career Development Fellow starts her three year MRC Skills Development Fellowship in August this year.

With the looming threat of an antibiotic resistance crisis we need to consider how best to preserve our existing antibiotics without compromising patient care. One of the ways to do this is to look at why some places have less resistance than others and to try to work out what they are doing right. For example, some hospitals have fewer infections with resistant bacteria than others.

Dr Knight’s project entitled “The dynamics of drug resistance within hospitalpopulations of Gram-negative bacteria” will build mathematical models of antibiotic resistance spread. These models will statistically explore what is happening in different hospitals and determine why some have lower rates of resistance than others with a focus on Gram-negative bacteria. These bacteria are often found living in the gut, but they can travel to other parts of the body and, in the UK, are the most common cause of serious hospital-associated infections such as bacteraemia (infection of the blood). Increasingly we are seeing strains of these bacteria becoming resistant to common, powerful antibiotics and so they are a key contributor to the UK burden of antibiotic resistance.

In this project Dr Knight will also explore diversity in fitness and resistance in bacterial populations and how this affects evolutionary pathways to resistance. Combining this with the information from the above hospital comparison she will then design new hospital-level mathematical models to inform intervention design. These model will be parameterised using hospital level data and will be directly useful for clinicians and the NHS. The model can be used to predict what will happen in the future without interventions and then compare this to what would happen if certain interventions were introduced. This would enable a better understanding of the processes underlying the spread of resistance and the key targets involved, and will directly influence the interventions used to control the appearance and spread of antibiotic resistance.