Title: Healthcare Associated Infections and Antimicrobial Resistance at Imperial College
Funder: Department of Health and Social Care

Abstract: One of our biggest global health threats is antimicrobial resistance (AMR). AMR occurs when microbes (e.g. bacteria, fungi) which cause infection, can no longer be treated by drugs designed to kill them (antimicrobials). Exposure to antimicrobials drives the development of resistance. Another interlinked health threat is healthcare associated infection (HCAI), which is infection arising through receiving healthcare. This problem is rapidly worsening as HCAIs are becoming increasingly drug resistant, making them even harder to treat and control. They are also the reason for about a third of the antimicrobial use in our hospitals. To tackle HCAI and AMR effectively, we must understand all the underlying causes and the factors that contribute to their spread. We need to find ways to identify which people are most at-risk, what actions can be taken to prevent or recognise drug resistance and HCAI earlier, and identify the best methods to improve antimicrobial use, e.g. developing and adopting new tools, or changing clinical practice or policy. We also need to assess the impact and cost-effectiveness of any action. We recognise the different skills required to answer these questions and will bring together researchers from a range of disciplines and professions including doctors, engineers, epidemiologists, microbiologists, pharmacists, behavioural scientists, economists and nurses. We will address HCAI/AMR comprehensively through four complementary themes: Priority Pathogens will investigate how and why microbes become resistant, why we see this more in some species or sub-groups than others, how to detect which infections are drug resistant and why some patient groups are more at risk than others. Precision Prescribing will work to optimise antimicrobial prescribing, preserving their effectiveness and minimising AMR by tailoring prescribing to the individual and the infection. Practice, design and engineering will explore ways of reducing HCAI/AMR through the use of intelligent design. It will consider redesigning the ways in which information is captured or presented to improve practice and behaviour, physical environments and patient pathways to reduce risk. Population health and policy will link large health datasets available locally and nationally. This will allow us to develop methods and tools for understanding risk at a population level and where to target action. It will also allow us to evaluate the impact of policies and interventions, including any unintended consequences. Throughout, we will educate, train and develop the next generation of researchers from different disciplines and professions, reducing HCAI and AMR and improving our public health and healthcare.

Lay abstract: One of our biggest global health threats is antimicrobial resistance (AMR). AMR occurs when microbes (e.g. bacteria, fungi) which cause infection, can no longer be treated by drugs designed to kill them (antimicrobials). Exposure to antimicrobials drives the development of resistance. Another interlinked health threat is healthcare associated infection (HCAI), which is infection arising through receiving healthcare. This problem is rapidly worsening as HCAIs are becoming increasingly drug resistant, making them even harder to treat and control. They are also the reason for about a third of the antimicrobial use in our hospitals. To tackle HCAI and AMR effectively, we must understand all the underlying causes and the factors that contribute to their spread. We need to find ways to identify which people are most at-risk, what actions can be taken to prevent or recognise drug resistance and HCAI earlier, and identify the best methods to improve antimicrobial use, e.g. developing and adopting new tools, or changing clinical practice or policy. We also need to assess the impact and cost-effectiveness of any action. We recognise the different skills required to answer these questions and will bring together researchers from a range of disciplines and professions including doctors, engineers, epidemiologists, microbiologists, pharmacists, behavioural scientists, economists and nurses. We will address HCAI/AMR comprehensively through four complementary themes: Priority Pathogens will investigate how and why microbes become resistant, why we see this more in some species or sub-groups than others, how to detect which infections are drug resistant and why some patient groups are more at risk than others. Precision Prescribing will work to optimise antimicrobial prescribing, preserving their effectiveness and minimising AMR by tailoring prescribing to the individual and the infection. Practice, design and engineering will explore ways of reducing HCAI/AMR through the use of intelligent design. It will consider redesigning the ways in which information is captured or presented to improve practice and behaviour, physical environments and patient pathways to reduce risk. Population health and policy will link large health datasets available locally and nationally. This will allow us to develop methods and tools for understanding risk at a population level and where to target action. It will also allow us to evaluate the impact of policies and interventions, including any unintended consequences. Throughout, we will educate, train and develop the next generation of researchers from different disciplines and professions, reducing HCAI and AMR and improving our public health and healthcare.

Research activity codes: 2.6 RESOURCES AND INFRASTRUCTURE (AETIOLOGY)
Health categories: INFECTION