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Last week, I had the privilege of attending the Genomics & Biodata Festival, a gathering of leading researchers, clinicians, policymakers, and industry experts shaping the future of genomic medicine. The roundtable discussion on antimicrobial resistance (AMR) and genomics, held in the Genome Dome, proved particularly illuminating.
The panel included Tim Rawson, Honorary Clinical Lecturer at Imperial College London, who specialises in precision prescribing; Susanna Dunachie, Director of the NDM Centre for Global Health Research at Oxford; Ronan McCarthy, Professor in Biomedical Sciences at Brunel University London; and Julian Parkhill, the pioneering Professor of bacterial genome sequencing from Cambridge University.
The Promise and Challenge of Genomic TestingWhole-genome sequencing (WGS) has emerged as a potential game-changer in predicting antibiotic resistance before treatment begins. This technology enables targeted therapy rather than broad-spectrum prescribing, though implementation remains challenging, particularly in resource-limited settings. Adoption of this technology at the bedside is closer than I realised, with mention of Oxford Nanopore being close to starting a trial across 32 ICUs.
The INHALE study (Norwich, Pandolfo et al.) highlighted a crucial obstacle: clinical behaviour patterns. Even with access to rapid molecular diagnostics, many clinicians default to broad-spectrum antibiotics due to ingrained habits, risk aversion, and workflow constraints. How could genomics be seamlessly integrated into clinical practice without disrupting existing workflows?
Critical Challenges in Antimicrobial ResistanceThe growing threat of untreatable gonorrhoea stands as a stark warning of AMR's progression. With ceftriaxone as the last consistently effective treatment option and resistance emerging, healthcare providers are exploring various strategies, including the targeted reintroduction of older antibiotics like penicillin in specific cases where susceptibility testing indicates it might be effective.
Source: UKHSA on gonorrhoea resistance
The global impact of AMR is staggering, with an estimated 4.95 million deaths associated with bacterial AMR in 2019, including both direct deaths and deaths where AMR played a contributing role. The MDM Centre for Global Health emphasises the importance of detailed patient-level records in tracking resistance patterns and informing public health interventions.
Source: Global burden of AMR study
Economic Barriers and Innovative SolutionsThe pharmaceutical industry's limited engagement in antibiotic development stems from fundamental economic challenges. Unlike chronic disease treatments, antibiotics offer low profitability due to their short-term use. Proposed solutions include government incentives, and public-private partnerships. Have these been used successfully in other situations? What can be learnt and applied to incentivise the pharma sector to engage more in tackling AMR?
Emerging Therapeutic ApproachesNovel approaches to combating AMR include phage therapy, which utilises bacteria-targeting viruses; host-directed therapies that enhance immune response; and biofilm disruptors targeting bacterial protection mechanisms. Vaccine development has also taken an innovative turn, focusing on improving body response to infections rather than complete sterilisation.
Source: Wellcome reports on AMR vaccines
Source: WHO report on AMR vaccines
Unexpected Influences on AMRPreliminary research suggests potential connections between artificial sweeteners and AMR gene exchange in gut bacteria. Although this emerging area of study requires further investigation to establish definitive links, it does raise interesting questions: How do non-antibiotic substances influence resistance? Should dietary changes be part of AMR treatment and prevention strategy?
The emergence of antifungal resistance, particularly in organisms like Candida auris, presents an additional challenge to healthcare systems. The complexity of diagnosing and treating fungal AMR underscores the urgent need for novel antifungal medications.
Source: CDC on antifungal resistance
The One Health PerspectiveThe festival emphasised the interconnected nature of human, animal, and environmental health in addressing AMR. This comprehensive approach requires coordinated surveillance across healthcare settings, farms, and environmental systems; strategic regulation of agricultural antibiotic use; evidence-based prescribing policies; and international collaboration.
Source: WHO on the One Health approach
Looking Forward
The festival's discussions revealed that technological advancement alone cannot solve the AMR crisis. Success requires a multifaceted approach combining improved prescribing practices, economic incentives for drug development, global genomic surveillance, and innovative antimicrobial strategies. The integration of genomics, artificial intelligence, microbiology, and public health will be crucial in addressing this challenge.