Antimicrobial Resistance Working Group meeting 30 November 2016
16 March 2017
Summary of the 14th meeting of the group
Role of Whole Genome Sequencing for Antimicrobial Resistance Surveillance
The group received a presentation (from Public Health England) entitled “The global transition from phenotypic to genotypic AMR surveillance – How do we get there?”. The talk highlighted the need to revolutionize Antimicrobial Susceptibility Testing (AST) the need for faster accurate diagnosis of resistant infections so as to ensure there is: better antibiotic stewardship, reduction in length or elimination of the need for broad-spectrum empiric therapy and reduction in selection pressure and collateral damage.
Members noted how WGS could be beneficial to microbiology in areas such as defining lineages and surveillance, in identifying biomarkers, assessing virulence and predicting resistance (it was underlined that PHE is particularly interested in whether WGS could be used to predict resistance).
The presentation discussed what WGS had to offer compared to phenotypic AST: the ability to look at several resistance mechanisms, differentiation between wild-type and non-wild type ECOFFFs, the generation of huge amounts of additional data, and (for some organisms) it is faster, e.g. for TB.
Members welcomed the presentation and in the ensuing discussion highlighted a number of points which include:
• WGS like other screening/detection methods can be a very useful tool for surveillance purposes but should not be relied on as a standalone tool
• WGS if employed appropriately with other screening tools currently used (in surveillance) might be able to distinctly pick up newly emerging pathogens, assist in the monitoring of trends and help to define how interventions are working
Update on the FSA surveillance strategy on AMR
The group was updated on the FSA’s surveillance strategy on AMR. Members had commented on the Agency’s proposed priorities for AMR surveillance in the food chain via teleconference that was held in October 2016.
Members were informed that the FSA’s Scientific Methods and Laboratory Policy Team have been mandated to progress the surveillance strategy and they are in the process of pulling together a tender for a call for work before the end of 2016. It was explained that the tender will commission work on the design and execution of a survey covering England, Wales and Northern Ireland on AMR in Campylobacter on fresh/frozen chicken sold at retail/wholesale and AMR in Salmonella on fresh/frozen minced pork sold at retail/wholesale. Sampling for study is expected to be in Spring 2017. Outcome of study is anticipated to be published by August/September 2017.
Members passed some comments on the sections of the study specification shared with the group.
Consideration of Danish paper on LA-MRSA and possible implications for risk assessment (Evidence for human adaptation and foodborne transmission of Livestock –Associated Methicillin-Resistant Staphylococcus aureus)
Members considered the above paper (published in Denmark in September 2016) in relation to the FSA’s risk assessment on MRSA, with a focus on LA-MRSA, in the UK food chain that the group had commented on and signed off (but was yet to be published). The study investigated the evolution and epidemiology of a novel livestock-associated methicillin-resistant Staphylococcus aureus strain, which colonizes and infects urban-dwelling Danes even without a Danish animal reservoir. Genetic evidence suggests both poultry and human adaptation, with poultry meat implicated as a probable source.
The group noted the findings in the study but agreed that they did not have any effect on the above mentioned risk assessment.
Update on the activities of DARC
The group’s attention was drawn to the findings of S.Typhimurium in livestock in England and Wales and to the unusual cases of DT104 which is making a comeback in cattle.
Members were informed of the publication of the following reports: Veterinary AMR and sales Surveillance 2015 (published in November 2016); Independent Review on AMR; AMR Review: Government’s response and the UK One health Report (antibiotics use in humans and animals).
FSA systematic review of AMR bacteria in pork, poultry, dairy products, seafood and fresh produce at UK retail level
The group was informed that the above study report was published on 25 November 2016. Member noted that the FSA is in the process of deciding on how to respond to the recommendations.
Establishing a short-term task on AMR
As part of the FSA’s new strategic approach to surveillance on AMR the group considered a proposal from the FSA Board to establish a short term “task-and-finish” scientific group. Members agreed with the principle of setting up the group whose membership would be all of the members of the AMR subgroup and additional expertise the group may lack. The group discussed the proposal and have asked for clarification on a number of points outlined in the FSA’s paper so as to be clear in the task it’s been asked to carry out.