Social factors contributing to antimicrobial resistance (AMR) in tropical northern Australia – a spatial epidemiology collaboration

An increasingly growing evidence-base of the burden of antimicrobial resistance (AMR) has uncovered inequality that exist within and between countries. In Australia, this is reflected by the disproportionately high prevalence of AMR in rural/ regional areas and amongst the Indigenous population. Australia has responded to the global calls to reduce antibiotic consumption and these efforts are essential in preserving the limited treatment options. However, factors other than antibiotic use are increasingly recognized as driving the AMR burden, in particular within vulnerable populations. This may in part explain why the Northern Territory (NT), despite using fewer prescriptions for some conditions, remains to demonstrate the highest community AMR rates in the entire country. Unpacking the social factors contributing to transmission and spread of AMR is important both for clinical management of patients and to mitigate risks of further spread. We sought to use a retrospective data of clinical isolates across northern Australia, combined with spatial demographic data to model potential factors driving AMR. Specifically, we will determine if access to hospitals, remoteness and socio-economic status of areas are associated with AMR prevalence.

In addition to producing innovative cross-disciplinary research in relation to the emergence of AMR in tropical northern Australia, this project will foster new and exciting collaboration between PRISM (KM) and HOT NORTH (TW) EMCR researchers. The individual and combined roles of each researcher are outlined as follows. TW is in the final stages of merging and cleaning a rich dataset of clinically important infections (resistant and susceptible) across three jurisdictions in northern Australia. She will provide data to KM containing organism and antibiotic resistance profiles, stratified by date of testing, site of infection (blood, urine, swab) and geography (ABS, SA3 regions). KM is a mathematical modeller with an interest in utilizing spatial information to enhance understanding of infection transmission, particularly around the impact of population mobility on long term disease dynamics. KM will use her modelling expertise to estimate human movement patterns as a proxy to determine the likelihood of health service accessibility for the people of northern Australia. Together, KM and TW will work to provide a project that demonstrates a role of population mobility, remoteness and socio-economic factors in the spread of AMR. This will be the first step in identifying ‘social factors’ potentially important for an effective response against AMR. This collaboration will provide both researchers with an invaluable opportunity to expand their respective research portfolios, build their current track record with at least one combined high-impact publication, present at both PRISM and HOT NORTH conferences and to apply for competitive grants in 2019/2020 (please see below). Through this unique combination of skills and passion, this collaborative partnership will provide an opportunity for innovative translational research discovery conceptualized and executed by EMCRs working on polar ends of Australia.