AMR: local, national, global impact

To fight antimicrobial resistance, researchers at MORU utilise hospital data to assess global impact and guide interventions. By analysing data, they identify hospitals needing support which enables targeted interventions. Automation and simplification aid data utilization in low-middle-income countries. This approach, bridging implementation and epidemiological research, is crucial and has the potential to save many lives.

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The Head of Microbiology at Mahidol-Oxford Tropical Medicine Research Unit (MORU), Mahidol University, since January 2012, Direk Limmathurotsakul also holds a Wellcome Intermediate Fellowship in Public Health and Tropical Medicine. Besides facilitating other researchers’ work, Direk runs his own fellowship-funded research programme, “Reducing the global burden of melioidosis”. From January 2014 to December 2015, Direk was also the director of Southeast Asia Infectious Clinical Research Network (SEAICRN).

Melioidosis, an often-fatal infectious disease caused by bacteria Burkholderia pseudomallei, is one of Direk’s main research areas. He led a series of laboratory and clinical studies, and demonstrated for the first time that ingestion and inhalation are important infection routes for melioidosis in northeast Thailand. He also developed the first evidence-based guidelines for the prevention of melioidosis for people living in endemic areas. Direk is a chair of International Melioidosis Society (IMS) with a mission to facilitate communication among member of IMS and people with an interest in melioidosis, and to create awareness about melioidosis among medical and veterinary professionals, scientists, health planners, policy makers and the general public in different parts of the world and to support the melioidosis research community.

Antimicrobial resistance is also one of Direk’s main research areas. By integrating routinely collected data from a range of databases he estimate that around an extra 19,000 deaths are caused by multi-drug resistant bacteria in Thailand each year. Thailand has a population of about 70 million, and so, per capita, this estimate is about 3 to 5 times larger than those for the United States and European Union (which have a populations of about 300 million and 500 million, respectively). He also shows that more of the bacteria collected from patients are resistant to multiple antimicrobial drugs and that the burden of antimicrobial resistance in Thailand is worsening over time. These findings suggest that more studies with a systematic approach need to be done in other low- and middle-income countries, especially in countries where microbiological laboratories are readily available and routinely used. Further work is also needed to identify where resources and attentions are most needed to effectively fight against antimicrobial resistance in low- and middle-income countries.

Direk is also an expert in Bayesian statistics and statistics for evaluating diagnostic tests. He developed a user-friendly open-access web-based application, that allows general researchers to apply imperfect gold standard Bayesian latent class models to their own data sets.