1. The role of PHE’s AMRHAI Reference Unit Professor Neil Woodford Antimicrobial Resistance & Healthcare Associated Infections (AMRHAI) Reference Unit © Crown copyright

2. What does AMRHAI offer ? Susceptibility testing for confirmation of exceptional resistances Infer resistance mechanisms from antibiograms Investigation of priority resistance mechanisms Strain typing to aid outbreak investigation Treatment advice; infection prevention & control advice + Research (externally-funded) + Evaluations of new drugs and diagnostics (externally-funded) 2UK-Russia (Moscow), 18th December 2015 © Crown Copyright

3. My Unit’s goals Setting England’s (the UK’s) Resistance and HCAI Problems into National and Global Context Better understanding of (resistant) bacterial clones distribution (global, national, regional) contribution resistance plays to success Coordinated surveillance of mechanisms global, regional and national Identify geographic ‘hot spots’ and ‘high risk’ patients early, targeted IPC interventions 33UK-Russia (Moscow), 18th December 2015 © Crown Copyright

4. Feed into the UK’s integrated surveillance of AMR risks Colonized residents or visitors Non-human reservoirs: animals and environment Victims from conflict zones Hospital treatment or travel overseas Multiple risks to be assessed to minimize damage We need better intelligence Inter-hospital transfers (UK) Non-human reservoirs: foodstuffs (domestic or imported) 4UK-Russia (Moscow), 18th December 2015 © Crown Copyright

5. AMRHAI works with PHE’s surveillance scientists Pathogen% carbapenem resistance 200820092010201120122013 E. coli0.080.090.110.180.250.22 K. pneumoniae0.70.40.61.21.11.6 5UK-Russia (Moscow), 18th December 2015 © Crown Copyright Data, courtesy Prof Alan Johnson Provides specialist microbiology that seeks to explain trends Is at the centre of a national / regional laboratory network Benefits from a ‘spider’s web effect’ Monitors new and emerging AMR issues, long before they register in surveillance programmes

6. CPE in the UK, 2000-2014 Klebsiella spp. 79%; E. coli 12%, Enterobacter spp., 7%; others 2% 6UK-Russia (Moscow), 18th December 2015 © Crown Copyright AMRHAI, Unpublished data Early cases often imported Imported & ‘home grown’

7. WGS-based genotypic antibiograms could ‘soon’ replace much AST for surveillance purposes low impact of the low error rate could ‘soon’ reduce need for AST in reference laboratories unless to guide treatment for agents with poorest genotypic/phenotypic concordance comparative in-vitro activity of new agents EUCAST Subcommittee on the role of whole genome sequencing (WGS) in antimicrobial susceptibility testing of bacteria Chair: Neil Woodford, London UK; will report in mid-2016 7UK-Russia (Moscow), 18th December 2015 © Crown Copyright

8. Working with academia 8UK-Russia (Moscow), 18th December 2015 © Crown Copyright Health Protection Research Units in HCAI and AMR Imperial College and PHE (Alison Holmes and Alan Johnson) University of Oxford and PHE (Derrick Crook and Neil Woodford) National research units involving a network of relevant, world class expertise that can comprehensively address the challenges of AMR and HCAI, with the resilience and capacity to respond to emerging issues and public health priorities Creating integrated programmes of research to develop new, cost-effective approaches for detection, surveillance, investigation and reduction of HCAI and AMR in the NHS

9. Working with industry 9UK-Russia (Moscow), 18th December 2015 © Crown Copyright extensive collections of MDR clinical isolates independent evaluations of: diagnostics AST platforms developmental antibiotics Active vs. >90% UK CPE

10. AMRHAI is a WHO Collaborating Centre Participate in missions and training courses AMR and/or IPC Promote reference microbiology for AMR Reference testing and characterisation of isolates received Supply ‘control ‘ isolates Promote research/development in reference laboratories Host overseas visitors on short or long-term placements Support applications for funding Seek funding for WHO CC activities Lobbying Groundwork for bids to The Fleming Fund in 2016 10UK-Russia (Moscow), 18th December 2015 © Crown Copyright

11. National & international capacity building Without lab testing we’re blind to (the extent of) AMR problems Improve lab access; aim for a reference lab in every country / region Each serving as the hub of a national network Each acting as a spoke in an international network Performing essential techniques, proficient to international standards Sharing data / experience 11UK-Russia (Moscow), 18th December 2015 © Crown Copyright