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£2.5 million project to tackle antibiotic resistance

University of East Anglia researchers are part of a new £2.5 million project to improve hospital treatment for patients with pneumonia and tackle the problem of antibiotic resistance.

They will develop and evaluate new tests to identify bacteria and their antibiotic sensitivities in under four hours. 

If successful, this will mean that patients get the right antibiotic sooner and that doctors can better manage their stock of antibiotics - which is threatened by the accumulation of resistant bacteria.

The five-year programme, entitled ‘INHALE: Potential of Molecular Diagnostics for Hospital-Acquired and Ventilator-Associated Pneumonia in UK Critical Care’ has been made possible thanks to funding from the National Institute for Health Research (NIHR).

Dr Justin O’Grady and Prof David Livermore from UEA’s Norwich Medical School will collaborate with clinicians and scientists from University College London (UCL) and University College London Hospitals (UCLH) – led by Dr Vanya Gant and Dr Vicky Enne in London.

To treat severely-ill pneumonia patients effectively with the right antibiotic, doctors must know which bacteria are responsible.

Current tests take two days or more and, in the meantime, a ‘broad-spectrum antibiotic’, capable of killing many different types of bacteria, is given until the results are available.

Dr O’Grady from UEA’s Norwich Medical School said: “This isn’t ideal. Some patients with pneumonia symptoms don’t have a bacterial infection. Others have highly resistant bacteria, which are not killed even by the broad-spectrum antibiotic - and this doubles the risk of death in severe pneumonia.

“On the other hand, many pneumonia patients have very susceptible bacteria and are over-treated until the lab result becomes available.  This overtreatment leads to undesirable side effects, for example C diff diarrhoea, and promotes resistance, making future infections harder to treat.”

The team will study new ‘molecular diagnostic’ tests, which aim to identify bacteria and their resistances directly from their genetic signatures in respiratory secretions - with results in under four hours.

This will allow treatments to be refined earlier, benefitting individual patients and allowing the most potent antibiotics to be reserved for those who really need them.

The team will test samples from patients with suspected pneumonia in the intensive care units of four hospitals, carefully chosen to represent different patient types and rates of resistance.

They will test three new molecular diagnostic systems to see how accurate they are and see how easy they are to use. They will then select the best test and compare it to conventional treatment in a clinical trial, with half the patients receiving treatment guided by the new molecular diagnostic while the other half receive treatment guided by current practice.

Clinical outcomes and the quality of antibiotic choice will be compared across the two groups, asking whether the molecular test allows equal or better outcomes with less use of broad-spectrum antibiotics. The team will also review whether savings from treatment and better use of antibiotics offset the extra cost of the test.

Dr Gant from UCL and UCLH said: “We need to know how well these tests agree with current methods. Do they find all the important types of resistant bacteria? Do they represent value for money? And will doctors act upon the result? INHALE addresses these important questions.”

Prof David Livermore from UEA’s Norwich Medical School added: “If we use antibiotics better – a precision strike rather than carpet bombing – we can cure patients and slow the development of antibiotic resistance. 

“The O’Neill Commission, which Prime Minister David Cameron set up to review antibiotic resistance, has stressed the potential of diagnostics, and this project will test this potential in a large and critically-ill group of patients.”

The INHALE study is supported by the NIHR Biomedical Research Centre at University College London Hospitals NHS Foundation Trust and University College London.

The award is in addition to 16 announced today by the NIHR, the research arm of the NHS, which has invested more than £15.8 million to date in this theme, with funding of further projects expected.

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