Antimicrobial Resistance

Our research encompasses the spectrum of important AMR infections in the region, including multi-drug resistant (MDR) Gram-negative bacteria, Mycobacterium tuberculosis, and artemisinin resistant Plasmodium falciparum. Our objective is to understand and reduce antimicrobial use (AMU) and antimicrobial resistance (AMR) in agriculture, the community, and in hospitals. Our research is interdisciplinary and many of OUCRU’s research groups are engaged in AMR research.

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Reducing resistance by reducing antimicrobial consumption and improving antimicrobial use

We aim to determine whether antibiotic consumption can be sustainably reduced in humans and animals without adversely affecting human health or agricultural yields.

Using an established network of chicken and pig farms in southern Vietnam we study the main determinants of antibiotic use and investigate whether antimicrobial consumption can be reduced by providing farmers with basic veterinary training, diagnostic laboratory support, and alternative disease prevention strategies.

In humans, we perform studies aimed at reducing antimicrobial consumption in healthcare. In community settings a mix of interventions have and will be trialed and evaluated for efficacy and cost effectiveness: rapid point-of-care testing for C-reactive protein, treatment algorithms, and financial incentives. In collaboration with behavioral scientists and our public engagement group we evaluate potential communication strategies and incentives to reduce the demand for antibiotics by the general public.

In hospitals we aim to improve rational antibiotic use and improve patient outcome by rapid microbial diagnostics and evidence-based treatment guidelines using a network of hospitals already engaged in tackling antibiotic overuse and resistance. Within the hospital setting, critical care is at the epicenter of the AMR problem and we have a number of studies aimed at reducing the use of antibiotics, especially for ventilator associated pneumonia.

Understanding the generation, transmission and impact of drug-resistant microbes

In collaboration with the National Hospital for Tropical Diseases in Hanoi, we are funded by the Fleming Fund to develop a national AMR surveillance scheme and reference laboratory. Using this scheme, and our existing infrastructure of longitudinal community cohorts and hospitals, we have developed sampling strategies aimed at understanding the transmission patterns of drug resistant bacteria, including between humans and animals and between the community and hospitals using next generation sequencing techniques. Revealing transmission patterns in a high burden country is critical to refining intervention strategies.

In collaboration with the MORU, we will continue to conduct surveillance for artemisinin-resistant Plasmodium falciparum in both Indonesia (through EOCRU) and Vietnam. We will continue to monitor and map the susceptibility (in vivo) of P. falciparum to antimalarial compounds in Vietnam, particularly artemisinin, and determine the utility of new molecular markers of artemisinin resistance (K13 propeller genes).

We are using whole genome sequencing to rapidly predict drug susceptibility of Mycobacterium tuberculosis in collaboration with Derrick Crook and others from Oxford. We are conducting large prospective studies of MDR pulmonary tuberculosis, trying to understand the host and bacterial determinants of disease severity and treatment outcomes.

Improving the treatment of drug resistant infections

Clinical trials have been at the heart of OUCRU’s research for more than 25 years. We have conducted randomized controlled trials to determine the optimal therapy of drug resistant infections, including those caused by Salmonella Typhi and Paratyphi, Shigella, Mycobacterium tuberculosis and Plasmodium falciparum.

In collaboration with Medicines for Malaria Venture, industrial partners, and MORU (Thailand) we will continue to test new antimalarial drugs aimed at combating the global increase in drug resistance.  These will include the drugs KAE609 and OZ4390.

OUCRU faculty engaged in AMR research:

National AMR Surveillance in Vietnam:

Rogier van Doorn

Guy Thwaites

James Campbell

Animal/human AMR interface

Ngo Thi Hoa

Juan Carrique Mas

James Campbell

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Community antimicrobial use and AMR bacteria

Stephen Baker

Sonia Odette Lewycka

James Campbell

Buddha Basnyat

Abhilasha Karkey

Hospital-acquired AMR infection

Behzad Nadjm

Rogier van Doorn

Louise Thwaites

James Campbell

Abhilasha Karkey

MDR malaria

Tran Tinh Hien

Nguyen Thanh Thuy Nhien

MDR tuberculosis

Nguyen Thuy Thuong Thuong

Vijay Srinivasan

Guy Thwaites