Genomics and the management of antimicrobial resistance: current successes and future challenges
Antimicrobial resistance (AMR) is one of the great challenges facing 21st century medicine
The targeted use of genomics presents a valuable opportunity to support and enhance the ability of the health services to minimise ineffective use of antibiotics and antivirals, to combat the spread of resistance through improved infection control, and to ensure that these vital therapies continue to be effective in the years to come. Antimicrobial resistance (AMR) is one of the great challenges facing 21st century medicine.
The development of new antibiotics has slowed rapidly, with few new drugs in development. In addition, current antibiotics are becoming increasingly ineffective at treating some common infections. The emergence of bacterial infections, such as gonorrhoea, that are resistant to the antibiotics of last resort indicates that the number of untreatable infections could increase, leading to the return of a significant death toll from previously easy to treat infectious agents.
Antimicrobial resistance - responding to a growing threat
The UK government is adding antibiotic resistance to the National Risk Register of significant potential threats to the nation, and in 2013 launched a five-year strategy outlining how it plans to slow the development and spread of antimicrobial resistance. Measures central to achieving this aim include:
- Prompt diagnosis of infections
- Rapid identification of pathogen susceptibility to drugs
- Appropriate prescribing practice
- Robust infection control
Current strategies used to diagnose the presence of infectious pathogens and test their susceptibility to drugs, such as culture techniques or mass spectrometry, remain the quickest and most cost-effective approaches. Reductions in the incidence of infections caused by antibiotic resistant organisms, such as MRSA in healthcare settings, demonstrates that infection control in hospitals has improved significantly. However, the continued rise in other infections, such as multi-drug resistant tuberculosis (TB), coupled with the emergence of new drug-resistant organisms such as carbapenem-resistant Enterobacteriaceae, suggests there is still significant room for improvement in managing AMR in both community and healthcare settings.
In this briefing we explore ways in which the pathogen whole genome sequencing could underpin these improvements.