Lose the jargon, win the war — the fight against superbugs

University of Birmingham researchers have identified new mechanisms used by bacteria to resist antibiotics, just days after one of their number voiced her concern surrounding the EU and UK’s action plans to fight antibiotic-resistant infections.

Published in the journal Nature Communications, their study was the result of a decade-long research project at the university.

Using novel experimental approaches, involving whole genome DNA sequencing never previously applied in this area of research, the team at the university’s Institute of Microbiology and Infection identified strategies that bacteria use to protect themselves from antibiotics. The experts focused their research on E. coli, which can cause urinary and blood stream infections.

“We investigated a gene found in bacteria that is involved in resistance to multiple antibiotics,” said Professor David Grainger, senior author on the study. “Although we have known about this gene for many decades, the ‘nuts and bolts’ of how it provides resistance to antibiotics has been difficult to pick apart.

“Our research identified previously unknown roles for this gene in controlling processes that provide drug resistance.

“We found two completely unexpected mechanisms that bacteria use to protect themselves from antibiotics. One protected their DNA from the harmful effects of fluoroquinolone antibiotics, and the other prevented doxycyline getting inside bacteria.”

Dr Prateek Sharma, who did much of the experimental work, added, “The resistance mechanisms that we identified are found in many different species of bacteria. Therefore, our research could lead to the discovery of molecules that could be developed into new drugs that can treat bacterial infections.”

The study was co-authored by Professor Laura Piddock, one of the UK’s leading microbiologists, who only three days previously expressed her concern that confusing language and a lack of specific objectives are hampering the global fight against antibiotic-resistant infections. Professor Piddock has co-authored a report for the UK All-Party Parliamentary Group on Antibiotics calling for policymakers to focus on measurable objectives and simple language, a summary of which was published in The Lancet Infectious Diseases.

The World Health Organization (WHO) submitted a European Strategic Action Plan on Antibiotic Resistance to the WHO European Regional Committee in 2011, highlighting seven strategic objectives as guidance to national governments in European member states to address antibiotic use and resistance. In response, the EU and the UK government set out to devise their own plans to address the recommendations in the WHO policy document.

But the evidence reviewed for the report suggested that although some EU member states successfully implemented many of the WHO recommendations, some appear to have been overlooked. In particular, there was a lack of evidence to suggest any activity to restrict non-prescription use of antibiotics by people or off-label veterinary use of certain new or critically important antibiotics to human medicine.

Likewise, it appears that little has been done to evaluate the need for incentives to stimulate discovery, research and development of veterinary medicines to increase the likelihood that drugs will reach the market at the rate required to combat AMR.

“The UK has taken significant steps to meet the objectives of the EU Action Plan, which in turn satisfies the WHO Europe Strategic Action Plan,” said Professor Piddock.

“Yet there is an absence of objective and tangible outcomes by which to measure success of these plans and strategies. There is also a lack of consistency between the strategies in use of terminology, areas of compliance and recommendations, which makes it difficult to discern whether the EU and UK regional action plans have satisfied the overarching WHO Action Plan.

“The biggest weakness is the ambiguous nature of the words employed in the recommendations. This ‘jargon’ may limit the impetus for decisive government action in some areas and pose a challenge to finding evidence of fulfilment of the AMR strategy aims.”

The report made the following recommendations for use in future action plans to combat AMR:

• Use more specific and measurable objectives, and outline the means by which all activities should be evaluated, in all future strategies.
• Demonstrate how all future strategies should comply/align with the WHO Action Plan.
• Develop a harmonised collection of educational tools to address the problems of AMR and antimicrobial stewardship practices for both the public and those working in the healthcare and veterinary sectors.
• Use simple language in all communications.
• Monitor the efficacy of education campaigns through online channels.
• Coordinate a review of progress in the discovery, research and development of new drugs, including for the veterinary sector.

Image credit: ©iStockphoto.com/Brendan Hunter