Antimicrobial Resistance Surveillance in Malta:
Integrating WGS for the Molecular Characterisation of Clinically Isolated Carbapenem/Colistin Resistant Enterobacteriaceae
About AMR...
Antimicrobial resistance refers to the ability of bacteria to survive against the drugs that are used to kill them.
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The increased presence of antimicrobial resistance (AMR) is considered as a major threat to public health, both in the Maltese islands as well as globally.
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Certain bacteria display the widest range of resistance, and amongst these, Carbapenem-Resistant Enterobacteriaceae (CRE) are becoming a leading public health concern.
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Locally, monitoring of AMR is currently done using standard microbiology methods, whereby microbes are grown on culture plates and drug susceptibility tests are carried out. However, the introduction of molecular techniques, such as Whole Genome Sequencing (WGS) (which involves establishing the exact DNA sequence of the AMR genes), can provide a better understanding of the how this resistance develops.
What causes Antimicrobial Resistance and why is it a Problem?
AMR is primarily caused by the overuse and misuse of antimicrobial drugs in human and animal health, as well as in agriculture. As a result, treatable infections can become untreatable.
Patients undergoing certain medical procedures such as organ transplantation and cancer chemotherapy are prone to infection. If antibiotics are no longer effective, the risk of infection following these types of interventions would be extremely high.
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Addressing AMR requires a focused effort to preserve the effectiveness of existing antibiotics, promote responsible use, and invest in research for new treatments.
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The first step in combatting this global threat requires a thorough understanding of these microbes’ genetic make-up and patterns leading to resistance, as will be tackled by this project.
Background and General Objectives of the Project
The Ministry for Health and Active Ageing has a ‘Strategy and Action Plan for the Prevention and Containment of Antimicrobial Resistance in Malta 2020 – 2028’ which recommends that molecular typing capability of AMR is introduced for certain key microbes.
Malta has seen a steady increase in resistance rates for several key microbes, including carbapenem/colistin resistant organisms. As discussed above, the implementation of molecular methods, such as whole genome sequencing (WGS), can drastically improve AMR surveillance.
Thus, the general objective of this project is to improve the national AMR surviellance. This will enhance our knowledge on multidrug-resistant microbes and their transmission to humans. As a result, it will improve the quality of care provided at Mater Dei Hospital and offer insight for the development of improved public health policies.
Project Activities
This project will last for 24 months and the specific activites are listed as follows;
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Develop a project management structure,
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Procurement of essential items needed for the project,
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Implementation, verification and validation of the WGS protocol (including data analysis),
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Training of personnel on these new WGS protocols and data analysis to develop a knowledgeable work-force,
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Establishing a national public health information system and national database for AMR data.