Antimicrobial resistance is a global health threat that requires international collaboration between researchers from multiple disciplines

Around the world, millions of people are at risk of contracting infections and illnesses that cannot be treated becausethe causative agents superbugs are resistant to medicines. Antimicrobial resistance (AMR) in which bacteria, parasites, viruses and fungi have developed ways to survive treatments that once killed them is a serious threat to global public health.

At the University of Bristol, researchers from numerous disciplines are working together to understand and control AMR in an effort to save lives at home and abroad. The majority of the worlds efforts to address AMR are around bacteria, says Matthew Avison, a professor of molecular bacteriology at the universitys School of Cellular and Molecular Medicine. In the UK, E. coli causes more deaths than any other bacterium, he says. Over time, it has adapted and becomeresistant to the drugs that doctors had previously used to treat it.

His team investigates E. coli, among other pathogenic bacteria. But simply understanding a bacteriums structure and behaviour is not enough.

Our successes are really due to our work with other disciplines, Professor Avison says. Our discoveries, which would otherwise be fairly basic regarding the behaviour of bacteria, can be applied to useful things.

Professor Avison leads the Bristol AMR interdisciplinary research network, funded by the Wellcome Trust. At Bristol, were good at interdisciplinary work, he says. Because the geography of the university is relatively small, and were close to other departments and schools, we can physically interact with each other.

This is how he and his team came to work with a group of physicists and be instrumental in spinning out a company. There are ways you can visualise and collect data with instrumentation that we in the biological sciences arent familiar with, he says. There were physicists at Bristol, however, who were experts in optics and, through collaboration, developed a device that can visualise individual bacteria and watch them move.

This invention has important implications for testing whether bacteria are resistant to a specific antibiotic. Bacteria move differently in the presence of antibiotics, Professor Avison says. If the antibiotics are working and killing them, the bacteria eventually stop moving.

The bacteriologists supplied the physicists with antibiotics and bacteria, while the physicists provided an imaging technique not initially developed for use in the biological sciences. This technique, Total Internal Reflection Microscopy (TIRM), is the cornerstone of Vitamica, a spin-out company specialising in rapid AMR diagnostics, and is now being trialled in hospitals, testing bacteria in patients urine. TIRM can image how the bacteria behave when in the presence of a specific antibiotic: if they do not die, then they are resistant to that drug.

The reason why its so good is that its rapid, says Profesor Avison. You put a sample in and, in less than an hour, you can tell if the antibiotic will work or not. He reiterates that it is still being trialled, but that it is a potentially very important technology in the fight against AMR.

Another vital collaboration for Professor Avison is with colleagues in veterinary science. Kristen Reyher heads the AMR Force, a research group within the Bristol Vet School that examines key topics about veterinary AMR.

In our projects, weve tried to lead with behaviour and social science, she says. We realised that you can have the best solutions and know all the technical answers, but still not be able to change the situation because you arent communicating in the right way.

One recent project spearheaded a method of farmer peer-to-peer learning, to try and change their behaviour with respect to antibiotics. As a vet, I think about disease all day, every day, Dr Reyher says. I dont think about the myriad things that farmers have to balance, but their peers do. They are the best people to listen and challenge one another to be the best stewards of these important medicines.

This awareness of context is fundamental to Bristol researchers AMR efforts. Maria Paula Escobar, another researcher at Bristol Vet School, is interested in how farmers in different countries use antibiotics and how this has an impact on AMR. She has projects in Colombia and collaborates with Dr Reyher and Professor Avison on one in Argentina.

There is a perception that countries just need more time and more money to address excessive antibiotic usage through targets, says Dr Escobar. This lacks an understanding of the different cultural contexts in which antibiotics are used. Antibiotics are not always used for the same reasons and those involved are not always veterinarians and farmers. In Europe, you cannot get hold of an antibiotic if a veterinarian has not prescribed it. That is not the case in many countries.

Bristol researchers also have AMR projects in Thailand, China, sub-Saharan Africa and more. Were not just looking at this as a UK problem, Professor Avison says. Low-income communities, particularly in developing countries, are disproportionately affected by healthcare problems, including AMR. Overcrowding and poor sanitation, for example, are driving infections, and people cant get access to new antibiotics [that would fight resistant infections] they are stuck with the old ones.

And a global problem, such as AMR, requires global collaboration. We couldnt do our work [in other countries] without great collaborations with local researchers, Professor Avison says. All of the work we do involves people going out and collecting samples from farms, from the environment, from people, which is done by researchers in those countries.

Training local researchers is part of this support, he says. These skills are becoming increasingly vital in an age of AMR a problem which will never go away entirely.

I dont think well ever solve the problem, Professor Avison concludes. Bacteria are very adaptable. They will always evolve and come back to us. That is why researchers have to be adaptable, too.

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Taking the fight to superbugs - Times Higher Education (THE)