‘Playbook’ sets out ways to fight back against antimicrobial resistance

‘Resistance breakers’ and better genetic tests are among new ways that scientists could address antimicrobial resistance, a new paper suggests.

Bacterial colonies grown on an agar plate in combination with iron powder.

Bacteria use a range of strategies to evade antibiotics

Published today in Nature Reviews Microbiology during World Antimicrobial Awareness Week, academics from the University of Birmingham and the Quadram Institute have drawn together the latest research to detail ways in which some of today’s bacteria are evading the world’s existing antibiotic defences.

The team of microbiologists have detailed the “AMR playbook” that bacteria use to either render antibiotics ineffective or otherwise avoid them. As well as bacteria changing the targets that antibiotics look for, bacterial strategies for avoidance also include:

  • Reducing the permeability of bacterial membranes so antibiotics are less able to reach cells and get to work,
  • Efflux pumps that process antibiotics as toxic waste away from cells, and
  • Enzymes that act like a counterattack, either modifying or deactivating antibiotics

Among the potential lines of defence, the research team have highlighted the role of ‘resistance breakers’, compounds which can be taken alongside antibiotics to inhibit the defensive strategies employed by bacteria.

At present only one type of ‘breaker’ is currently being used, β-lactamase inhibitors which are taken alongside beta-lactam antibiotics, and the team suggest that advances in genomics and basic scientific understanding of AMR could lead to future breakers being trialled and used in future.

Dr Jessica Blair, Associate Professor in the Institute of Microbiology and Infection at the University of Birmingham and co-lead author of the paper said:

“Our understanding of antimicrobial resistance has been growing to meet the threat of a looming health disaster that left unchecked could send our defences against bacterial infection back to the pre-antibiotic era. This paper details the playbook of the different methods bacteria employ to evade antibiotics and continue to proliferate.

“Armed with the understanding of this playbook, we can fight back with smarter ways of using our existing range of antibiotics alongside new and potential compounds that soften up AMR defences and leave antibiotics to do their work.

“Gone are the days of ‘hit and hope’ antibiotic treatments for bacterial infections, and we now need to employ a precision approach to treating future AMR. We will only benefit from our increasing understanding of AMR and tackle the global health emergency that it is causing by seeing a significant shift in the funding and pursuit of the new generation of antimicrobial therapies.”

Gone are the days of ‘hit and hope’ antibiotic treatments for bacterial infections, and we now need to employ a precision approach to treating future AMR.

Dr Jessica Blair, Institute of Microbiology and Infection

Professor Mark Webber from the Quadram Institute and co-lead author of the paper said:

“AMR will be one of the biggest threats to human and animal health this century. In this paper we describe how bacteria can evade the drugs we rely on to treat infection but also identify how new methods and research can be used to develop the new treatments we urgently require”

Notes for editors

  • For media enquiries please contact Tim Mayo, Press Office, University of Birmingham, tel: +44 (0)7920 405040.
  • Darby, E.M., Trampari, E., Siasat, P. et al. 'Molecular mechanisms of antibiotic resistance revisited.' Nat Rev Microbiol (2022).
  •  The University of Birmingham is ranked amongst the world’s top 100 institutions. Its work brings people from across the world to Birmingham, including researchers, teachers and more than 6,500 international students from over 150 countries.The University of Birmingham is a founding member of Birmingham Health Partners (BHP), a strategic alliance which transcends organisational boundaries to rapidly translate healthcare research findings into new diagnostics, drugs and devices for patients. Birmingham Health Partners is a strategic alliance between seven organisations who collaborate to bring healthcare innovations through to clinical application:
    • University of Birmingham
    • University Hospitals Birmingham NHS Foundation Trust
    • Birmingham Women's and Children's Hospitals NHS Foundation Trust
    • Aston University
    • The Royal Orthopaedic Hospital NHS Foundation Trust
    • Sandwell and West Birmingham Hospitals NHS Trust
    • West Midlands Academic Health Science Network

About The Quadram Institute

  • The Quadram Institute is an interdisciplinary research centre at the forefront of a new era of food and health research. It brings together researchers and clinicians under one roof and houses one of Europe’s largest endoscopy units and a clinical research facility.
  • Based on the Norwich Research Park, the Quadram Institute is a partnership between Quadram Institute Bioscience, the Norfolk and Norwich University Hospitals NHS Foundation Trust, the University of East Anglia and the Biotechnology and Biological Sciences Research Council (BBSRC).
  • The Quadram’s mission is to deliver healthier lives through innovation in gut health, microbiology and food.