Infection and immunity – the challenge of antimicrobial resistance

Proudly organised by the Melbourne Medical School Student Ambassadors (MMSSA), the ReTranslate Symposia in Translational Science brings together world leaders from the fields of health and medical science to explore and discuss important healthcare issues.

Over the last three years, the annual event has been attended by the University of Melbourne Medical School community and alumni, who have gathered to explore a range of subject matter – neuroscience (2015), cancer (2016) and infection and immunity (2017).

Held at the Peter Doherty Institute for Infection and Immunity, last year’s gathering featured world leaders from the field of antimicrobial resistance (AMR). The director of the Institute, Professor Sharon Lewin, introduced the evening, setting the scene and highlighting the complexity of antimicrobial resistance. Five speakers and an expert panel took the audience on a journey through the issues: from agricultural and environmental factors to how we can track the origins of resistant strains (a lesson in phylogenetics based on familiar chocolate bars); the challenges in consultation rooms and hospitals; and, finally, the best opportunities for effective antimicrobial stewardship.

Professor Jodie McVernon highlighted interesting aspects of the historical context, likening the imprudent use of antibiotics in the medical profession to the era when doctors were advertising smoking. The analogy may be surprising, but future practitioners might marvel at the difference in attitudes and practice, as we do about old tobacco advertising. Professor McVernon went on to show crossover patterns of some resistant bacterial strains making their way from livestock to humans. Her final few minutes were awe-inspiring as she demonstrated the scale of the AMR problem. She cited recent research showing that one-third of travellers returning to Scandinavia were colonised by resistant bacteria.

Professor Benjamin Howden, a master of genomics, gave the audience a crash course in phylogenetic trees, using different brands of chocolate bars to illustrate the concept of genetic relatedness. Professor Howden described a recent movement
of resistant bacteria into Victoria, specifically a group known as carbapenemase-producing enterobacteriaceae. While the name might be a mouthful, he beautifully simplified the concept for the audience. He presented a map showing the many locations the bacteria had been found in Victoria, indicating this was not an isolated event but something requiring careful attention.

Professor Karin Thursky addressed the issue of “who’s being naughty and nice” within the realms of antibiotic prescribing. She suggested hospitals were doing well, with studies providing more prescribing information to doctors, rather than simply restricting their antibiotic choice, which was yielding results. That is, better outcomes came about by creating educational information and resources for doctors, rather than by adding bureaucracy to prescribing. Professor Thursky concluded with sobering statistics; 44.7 per cent of the Australian population in 2015 had antibiotics prescribed – 27 per cent of which were broad spectrum – with one-third showing no signs of symptoms attributed to the prescription. Naughty indeed.

Professor Cheryl Jones delivered the final speech, painting a possibly grim future for humanity if AMR was not adequately addressed. Occasionally, headlines report the death of a traveller returning from a developing country, but such deaths may be the tip of an iceberg. Professor Jones showed projections of 10 million deaths by 2050 due to antimicrobial resistant organisms that hinder simple procedures we currently take for granted, such as basic surgeries, intensive care and transplants.

The audience, the majority of which were current students and alumni spanning many years, brought enthusiasm to the event, pitching many questions to the panel, which was chaired by Melbourne Health chief executive Professor Christine Kilpatrick (MBBS 1976, MD 1986, MBA(Exec) 2007, DMedSc 2016). The students soaked up valuable insights, with one reflecting on the depth and breadth of the evening:

"It was privilege to be guided through a story from start to finish by the expert of each piece of that story, something we rarely get in traditional hourly lectures."

Another commented: “I enjoyed the discussion of the problems, but also the emphasis given to solutions and translation of knowledge.” An alumni member and rural GP asked about the pressures of pandering to patients’ wants, and the common perception that leaving an appointment with a script was evidence of a good consultation. The speakers and audience discussed this tricky situation, acknowledging the importance of maintaining the doctor-patient relationship while neutralising the simplistic view that more drugs was better and reaffirming the benefits of good communication and reassurance.

Following on from the success of ReTranslate 2017, we look forward to hosting global leaders in Maternal and Child Health in 2018, with a forum again geared towards stimulating discussion and debate.

Evan McRobb
Melbourne Medical School Student Ambassador Program