Antimicrobial Resistance and Healthcare Associated Infections

Antimicrobial resistance (AMR), the ability of microorganisms to resist being killed by antimicrobials, poses a major and rapidly growing threat to the prevention and treatment of infections, and to public health globally.

AMR occurs naturally, but emergence and spread of antimicrobial-resistant pathogens is accelerated by lifestyle factors, including excessive and inappropriate use of antibiotics, poor hygiene, poor infection control in healthcare, poor access to sanitation and drinking water, and increased international travel.

AMR pathogens are found in hospitals, among people in the community, in residential aged care, among domesticated and agricultural animals, and wildlife.

AMR impacts treatment of common infections, and is associated with higher mortality, prolonged illness in people and animals, compromised food safety, and loss of agriculture. AMR infections result in more complex care, jeopardising our ability to safely provide surgery, intensive care, organ transplants and cancer treatments, and increasing the financial burden on healthcare systems.

A broad range of pathogens can be antimicrobial-resistant, including MRSA (methicillin-resistant Staphylococcus aureus), VRE (Vancomycin-resistant Enterococci), highly-resistant Gram negative bacteria such as CPE (Carbapenemase-producing Enterobacteriaceae), and antimicrobial-resistant Gonorrhoea and Salmonella. AMR pathogens of global importance include tuberculosis, HIV and malaria.

The Doherty Institute addresses AMR using a ‘one health’ approach, recognising the critical link between human health, animal health, and the environment in the emergence and spread of AMR. Eliminating AMR will require multidisciplinary approaches to change policy, behaviour, regulation and scientific discovery. Numerous teams across the Institute work collaboratively to effectively utilise a broad range of expertise, enabling coordinated action to respond to the complex threat of AMR.

The Doherty Institute's expertise

AMR is a major focus for the Doherty Institute, with seven dedicated research groups, and more than 70 personnel, including 18 PhD students, undertaking a broad spectrum of activities spanning research, diagnosis, surveillance, training and clinical care.

In 2021 the Doherty Institute was formally designated a WHO Collaborating Centre for Antimicrobial Resistance. The WHO Collaborating Centre for Antimicrobial Resistance works under the leadership of the World Health Organization, particularly the Western Pacific Regional Office, to strengthen and build antimicrobial stewardship and laboratory capacity for diagnosis and surveillance of antimicrobial resistance (AMR).

Research

Major research initiatives at the Doherty Institute provide evidence to improve the prevention, detection and response to AMR.

Laboratory-based studies use cutting-edge technologies, such as microbial genomics and metagenomics, to detect the emergence and spread of new pathogens, develop new diagnostics and new therapies, and understand the impact of host-pathogen interactions on resistance.

The Institute’s antimicrobial stewardship program, working collaboratively with general practice and veterinary science, develops and evaluates interventions to minimise the inappropriate use of antimicrobial drugs. Antimicrobial stewardship guides improvements to antimicrobial prescribing and use in hospital and community settings, including aged care, agricultural, and veterinary sectors.

Clinicians at the Doherty Institute lead international, multicentre clinical studies to optimise the management of patients with infections caused by AMR pathogens.

Diagnosis

The Doherty Institute’s public health laboratories provide expert services in phenotypic and molecular resistance detection in bacteriology, mycobacteriology, and virology. Outbreak investigation and assistance with resistance testing is available to all Victorians. Our work aims to detect and characterise AMR pathogens of human, veterinary and environmental origin.

Doherty Institute laboratories work in close collaboration with departments of Health in Victoria and Australia. We partner with state-wide public health programs, such as the Victorian Tuberculosis Program and the Victorian CPE Surveillance and Response Unit, to improve the management, control and prevention of AMR pathogens.

Surveillance

Doherty Institute teams conduct state-wide monitoring and reporting of healthcare associated infections. Support is also provided directly to hospitals, through expert infection control program review, provision of tools and recommendations for quality and safety improvement.

The Institute’s public health and reference laboratories use combined genomic and epidemiological approaches to detect and monitor AMR pathogens, supporting state and national surveillance programs, informing public health responses, and assisting with the investigation of infection outbreaks.

Doherty Institute-led national antimicrobial prescribing surveys monitor antimicrobial drug use in hospitals, residential aged care, urban and remote primary care, and veterinary settings, highlighting areas of antimicrobial prescribing that can be improved to promote prevention of AMR, and informing policy and quality improvement initiatives.

Training

The Doherty Institute provides training locally and regionally in all aspects of AMR, including basic science, diagnostics, epidemiology, genomics, antimicrobial stewardship, surveillance, and clinical care. Training programs include undergraduate courses, postgraduate research, specialist courses, symposia, and accredited training positions in medical microbiology and infectious disease.

Clinical care

Specialist clinical care is provided at The Royal Melbourne Hospital for patients with antimicrobial-resistant infections. Digital tools for antimicrobial stewardship support hospitals to promote best practice antimicrobial prescribing and use.

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