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Unravelling the travel history of hospital-associated pathogens

An Interview with Prof. Sharon Peacock of Cambridge Infectious Diseases Interdisciplinary Research Centre.

Professor Peacock’s group aims to introduce high-throughput whole genome sequencing technologies into diagnostic and public health microbiology. Proof-of-principle will be achieved by a project to develop a system for real-time tracking of methicillin resistant Staphylococcus aureus (MRSA) transmission. This technology will subsequently be developed to track transmission of other important human pathogens, and the programme expanded to include genotypic drug susceptibility testing of slow growing pathogens. This work represents a close collaboration between the University of Cambridge, the Wellcome Trust Sanger Institute and the Health Protection Agency. Professor Peacock sits on the MRC Infection and Immunity Board, and the Medical Technologies Advisory Committee, NICE (National Institute for Health and Clinical Excellence).

What led you to become interested in your area of research?

Each year, millions of patients around the world are affected by healthcare-associated infections. This problem is compounded by the fact that the pathogens involved are frequently resistant to the antibiotics that are prescribed before the antibiotic resistance profile can be defined. This can result in ineffective therapy and a poor outcome for the patient. Antimicrobial resistance is likely to have the greatest impact on health in developing countries where the cost of effective antibiotics against multidrug resistant pathogens are prohibitive. The emergence of new strains of drug resistant bacteria is inevitable because of the speed at which they evolve, but rapid detection of strains that are of public health importance combined with real-time tracking of pathogen transmission can inform prescribing policies and infection control procedures to limit their impact on human health. The current tools available to track pathogens are inadequate for many bacterial species because they lack sufficient discrimination. My group aims to develop technologies that represent solutions to this problem.

What’s the most exciting thing about your research at the moment?

We are on the cusp of a major breakthrough in diagnostic and public health microbiology, with a real possibility of translating high-throughput whole genome sequencing into clinical practice. This will also accelerate our understanding of bacteria, including mechanisms of drug resistance, and the ways by which bacteria cause disease in humans and animals. In order to harness such power, we will need to reduce the cost and turnaround time of sequencing, and develop software that undertakes automated analysis and provides output data that can be interpreted without in-depth knowledge of bioinformatics.

How has working with partners in Thailand for over seven years  influenced your research?

I was head of the bacterial diseases research programme at the Wellcome Trust Major Overseas Programme based in Bangkok. Our programme aimed to address questions that were important in several countries in southeast Asia, and included randomised controlled drug trials, developing and evaluating diagnostic tests, clinical epidemiology, and determining mechanisms of drug resistance. Such work has contributed towards national and international guidelines for the diagnosis and treatment of some of the prevalent infectious diseases in this region. One aspect of the programme that differs from most research programmes in the West is that we had to be sufficiently flexible to respond to new problems as they arose. For example, we responded to an increased number of cases of melioidosis (a bacterial infection caused by an organism in the soil called Burkholderia pseudomallei in which we had expertise) in Southern Thailand following the Tsunami of 2004, and provided teaching on case recognition, culture techniques and identification, and treatment. This is an example of where researchers can also provide healthcare benefit to the community in real-time.

Who has influenced you most in your career?

I have worked with many outstanding people, but the colleague who had the greatest influence on me was Dr Douglas Chamberlain, a consultant cardiologist in Brighton who I worked for as a junior doctor. His absolute dedication to his patients, together with his insistence on quality of care through training and educating the next generation of physicians, was outstanding. His energy, enthusiasm and sense of humour never waned, and he was an extraordinary role model.

What is the most important lesson life has taught you?

To fix my sights on what I believe to be important, and to deconstruct setbacks to understand how to overcome them.