0:00
Hello,
my name is David Livermore,
I'm Professor
of Medical Microbiology
for the University
of East Anglia in Norwich.
I'm also Public Health
England's lead
on Antibiotic Resistance.
And for 14 years,
I headed Public Health
England's National
Reference Laboratory
examining antibiotic
resistant bacteria
in the United Kingdom.
What I want to do
in this two-part presentation
is to look at
national and international surveillance
of antibiotic resistance.
0:38
In this first part,
I want to look
at how data can be collected
for surveillance of resistance.
Why we seek to do surveillance,
and some of the pitfalls
and challenges with the data.
In the second part,
we'll look more
at some of the data
that have been collected
and their interpretation,
and how that can be used
to assess
the success or failure
of interventions.
1:14
The reasons to do
surveillance of resistance
are really pretty obvious.
Firstly, to identify changes
in prevalence and trend,
to detect
new types of resistance
as they emerge.
Is the MRSA rate going up?
Is it going down?
Have we started
to see something new appear?
Resistance to Carbapenems
in Gram-negative bacteria,
for example,
or new emerging
Colistin resistance.
Surveillance is also important
to assess the coverage
of empirical therapy.
Now this always comes as
a surprise to the non-medics,
but usually you start
treating an infection
without knowing
what the pathogen is.
You've got a sick patient there.
You've clinically diagnosed them
as having
urinary tract infection
or being potentially septic.
They need antibiotics now!
Not after the two days or so
that is going to take you
to grow the bacteria into test
which antibiotics
are susceptible to.
So, you need an idea of what
are the most likely bacteria
in urinary tract infections
or sepsis or whatever
and what the local prevalence
of resistance is,
so you can choose
what antibiotics
to give that patient
upfront here and now
before you've got
the susceptibility results
for the particular organism
from the lab.
Hopefully, after two days,
once you do have those results,
then you're going to be fine
with the treatment.
You'll step down
from a broad
spectrum antibiotic,
one that's covering
all the likely types
of pathogen locally
in that clinical setting,
to something narrow spectrum
that's tailored against
the particular bug
that's been growing
from the patient.
Lastly, we need surveillance
to assess the impact
of interventions.
We take steps,
improvements
in infection control,
better hand hygiene,
whatever to try
to combat our problems,
well, let's say MRSA
or Clostridium difficile.
We need surveillance
to know if our interventions
have succeeded or if they failed.
