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By  Naomi Stekelenburg Morgan Gilbert 8 January 2024 4 min read

Key points

  • Understanding patterns of antimicrobial resistance (AMR) in different places is important for choosing the right antibiotic to treat an infection.
  • We have developed a program called HOTspots for surveillance of antibiotic resistance across Australia.
  • Our program helps health professionals prescribe appropriate antibiotics to people living in rural and remote areas.

When you take an antibiotic, you are taking an agent that can kill or slow the growth of microorganisms. This has been a boon to modern medicine, helping us treat infections that were once life-threatening.

Unfortunately, organisms are becoming increasingly resistant to many treatments, including antibiotics. This is called antimicrobial resistance (AMR).

Due to the rise in AMR, picking the right drug for the right bug at the right time is now harder than ever. It's why doctors often send a sample from the patient to a pathology lab. This can help determine which antimicrobial agents are effective.

However, testing can take days. Wait times can be even longer in rural and remote regions of Australia. What if you need treatment right away?

[Music plays and several technology-related images appear inside a circle on the screen. The CSIRO logo appears from the circle. The vision cuts to Teresa Wozniak, CSIRO Research Scientist, who is sitting in a room with plants in the background.]

TW: We know that antimicrobial resistance is a global problem in Australia. The problem is hidden – national surveillance activities don'tactually capture the most vulnerable populations of Australia.

[Screen cuts to Branwen Morgan, Lead of CSIRO’s Antimicrobial Resistance Mission, seated on a soft armchair in a small room. The video is framed in white and in front of a pale blue background.Branwen has headphones on and is speaking directly to the camera.]

BW: The Minimising Antimicrobial Resistance Mission has been co-designed with the Department of Health and Aged and the Department of Agriculture, Fisheries and Forestry. And what we're really working to do is to halt the rising death rate and economic burden of antimicrobial resistance in Australia by 2030.

[Screen cuts to Bhavini Patel, Executive Director of Medicine Management of NT Health, sitting in front of a hallway in amedical facility.]

BP: At the moment, if you go and visit your GP, your general practitioner, or visit a remote health center and they think you've got an infection, there's no clear way of understanding what the right antibiotic is going to be based on local resistance patterns.

[Screen cuts to Anne Kleinitz, a Senior Rural Medical Practitioner, seated in a bright, open room with comfortable chairs.]

AK: As doctors, we look after a population that covers a really large geographical area. 

In all those areas, the antimicrobial resistance varies.So having a platform that can giveus data specific to each region will be really useful

We have this sort of data, we can feel confident that perhaps, for example, a narrow spectrum antibiotic may really work for this patient and we can confidently use it.

[Screen cuts to Amy Legg, a pharmacist, who is sitting in a nondescript room in front of a glass wall.]

AL: The HOTspots platform is a new platform that's been developed. 

What it does is it takes data that we have been collecting and really been concentrating in some of the major areas such as Darwin and Alice Springs, and makes it relate to some of the more remote areas where we actually see a really high burden of infections. 

What'sreally interesting about the sort of data and reporting that we do is it's mandated that we do report on our antimicrobial resistance patterns. But a lot of that data hasn't necessarily been optimally used in terms of guideline writing. 

Now what we'll have is really robust data to drive probably significant differences that will help optimise care for our patients because we'll have access to this data for them and where they live.

[Screen cuts back to Bhavini Patel.]

BP: The great thing about HOTspots is this allows each region to have its own antibiotic biogrambased on the infections and treatment that's occurred over the last twelve months. 

The HOTspots data actually allows the clinical person to have a look at what the sensitivities were for those likely infection bugs and make that decision a lot quicker.

[Screen cuts back to Teresa Wozniak.]

TW: So not only are we looking to diversify geographically with HOTspots program, we recognise that antimicrobial resistance goes across the one health sector, and we want to expand the HOTspotsprogram beyond human antimicrobial resistance.

[Screen cuts back to Branwen Morgan.]

BW: What'sreally important to the mission is that we form enduring collaborative partnerships. 

That is why surveillance platforms such as HOTspots are incredibly important to help us get that data and to really understand what is going on in society. 

When we think about what we might actually need to halt the rising death rate and economic burden of antimicrobial resistance, we can't just think about the technological solutions. We have tothink about the environment in which they'll be used and also the behavioural change that will be required. Because unless we have an enabling ecosystem ― so where there's appropriate fundingappropriate policy some of these solutions will never have the impact that we want them to have.

[Screen cuts back to Bhavini Patel.]

BP: I'mreally excited to see the HOTspots come into clinical practice, because it's got great benefits for patients. It'll reduce the workload of clinicians and have a really major impact on improving antimicrobial stewardship across the top end.

[Screen cuts back to Teresa Wozniak.]

TW: The need for the HOTspotsprogram really came from the ground. It came from building very strong relationships and partnerships with local clinicians, with local policymakers. 

Importantly, the HOTspots program has two components. It has the disease surveillance component. It also has the component where that information is then used for action. 

Currently, over 200 sites contribute to the HOTspots program. We get data directly from pathology providers, from hospitals, community clinics, and GP practices. 

So what does the future hold for HOTspots? Well, HOTspotsis expanding. Humans aren't the only creatures that are affected by antimicrobial resistance, and we need to better understand how antimicrobial resistance fits within the ecosystem of One Health.

We want to go beyond Northern Australia, and we think that the HOTspots app can be used as a national atlas for antimicrobial resistance.

[Screen fills with white and the CSIRO logo appears.]

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AMR patterns in regional Australia

Sometimes health professionals have no choice but to prescribe antibiotics based on the evidence available to them. But in some areas of Australia, particularly rural and remote regions, there is little data on patterns of antimicrobial resistance.

This means the chosen antibiotic may not be effective against the bacteria causing the infection. In addition, inappropriate prescribing of antimicrobial agents also drives further antimicrobial resistance.

How can health professionals in regional Australia make confident and responsible decisions at the point of care?

Image of 4-wheel drive vehicle driving on a dirt road in Northern Australia
A vehicle driving through a remote area in Australia

Top tech for the Top End

Dr Teresa Wozniak, leader of our Digital Solutions for AMR (DS4AMR) team, is passionate about addressing health and healthcare inequity in Australia.

“We know that antimicrobial resistance is a problem in our country, but the problem is hidden. This is because national surveillance activities don't include the most vulnerable populations,” Teresa says.

The burden of AMR is highest in regional and remote areas of Australia due to factors such as remoteness, low healthcare resources and high staff turnover. The lack of data on antimicrobial resistance patterns in these areas is exacerbating the problem. 

That’s why Teresa and her team founded HOTspots, an antimicrobial resistance surveillance, mitigation and education program. The program collects AMR data from hundreds of healthcare settings around northern Australia. Most of the data comes from more densely populated regions.

Amy Legg is a pharmacist at the Royal Brisbane and Women’s Hospital. She says HOTspots uses this information to gain insight into areas where data is scarce.

“It takes the AMR data that we have been collecting in major areas like Darwin and Alice Springs and makes it relate to some of the more remote areas,” Amy says.

The result is region-specific data on antimicrobial resistance patterns.

Improving remote medical care

Amy is excited about how the technology can be used at the point of care to improve patient outcomes.

“We can optimise care for our patients because we'll have access to data that’s specific for where they live, even if it’s a remote location.”

Anne Klenitz is a Senior Rural Medical Practitioner in Remote Health. She says that the value of this cannot be understated.

“As doctors, we look after a population that covers a large geographical area. In all those areas, the antimicrobial resistance varies,” Anne says.

“Having a platform that can give us data specific to each region is really useful.”

The data is displayed via an interactive digital platform. Clinicians, researchers, and policymakers can readily access the accurate and up-to-date information.

It takes a village (to treat antimicrobial resistance)

Teresa and her team work closely with health professionals in the affected areas. 

Over 200 primary health clinics and hospitals currently provide data to HOTspots.

Some parts of Australia are remote and there is a gap in data about AMR in some of these areas.

“The need for the program really came from the ground. It came from building very strong relationships and partnerships with local clinicians and policymakers,” Teresa says.

“The key to moving forward is maintaining existing partnerships and bringing new collaborators on board.”

This goes hand-in-hand with the education component of the HOTspots program.

Health professionals can complete CCP-accredited training on antimicrobial resistance as part of their professional development.

The HOTspots program is also involved with the Australian Antimicrobial Academy. Health workers or health professionals working in the Aboriginal and Torres Strait Islander health sector can gain skills related to antibiotic use, auditing, stewardship, surveillance and resistance.

Using data to defeat AMR

It’s all part of using antimicrobial resistance data for action.

Amy is excited about the potential of HOTspots to encourage the effective use of AMR information.

“It’s already mandated that we report on antimicrobial resistance patterns. But a lot of that data hasn't been optimally used in terms of guideline writing,” Amy says.

“Now we'll have really robust data to drive action.”

Branwen Morgan, leader of CSIRO’s Minimising Antimicrobial Resistance mission, says that access to this data is an important aspect of responding to AMR holistically and effectively.

“Unless we have an enabling ecosystem with appropriate funding and appropriate policy, some of the solutions we come up with to combat AMR will never have the impact that we want them to have,” Branwen says.

Addressing health and healthcare care inequities between urban, rural, and remote regions is critical in ensuring that all Australians are protected. Teresa and her team are working on expanding the geographical reach of the HOTspots program.

“We want to go beyond northern Australia. We think that the HOTspots app can be used as a national atlas for antimicrobial resistance,” she says.

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