Ben Cooper: Drug-resistant infections and disease dynamics

My name is Ben Cooper, my area of research is infectious disease epidemiology. I study infectious diseases, both trying to quantify the burden of disease due to those diseases, but also trying to understand and develop interventions to reduce that health burden.

One example of a recent research project from my team was a randomised control trial which we conducted in three countries in Southeast Asia: Thailand, Nepal and Singapore. We were trying to see if we could safely reduce the duration of antibiotic treatment for ventilator-associated pneumonia, it's a lung infection that many patients get in ICU when they are mechanically ventilated, when they have artificial breathing, and this infection accounts for a very high proportion of total antibiotic use in intensive care units. If we could safely reduce that, we could reduce the amount of antibiotic use which would both reduce patient side effects and also reduce the selection for antibiotic resistance in bacteria. This project was led by Dr Mo Yin, who at that time was my DPhil student here. It was a major achievement to get this study running, and it was successful in that it showed we could safely reduce antibiotic duration treatment from about 14 days till about 6 days, and that was associated with a big reduction in side effects in patients. Alongside that, we also did some mathematical modelling to develop the theoretical basis and understanding for how reducing treatment duration would be expected to affect antibiotic resistance.

The big questions in my field, I guess we've established through work with University of Oxford in collaboration with University of Washington that the burden of antimicrobial resistance globally is huge, accounting for between about 1 and 5 million deaths per year. The big challenge now is to develop effective interventions to reduce that burden. And there are multiple things we can do. There's improving infection control in hospitals; there's improving the way we use antibiotics both in the community and in hospitals; there are behavioural interventions about that usage of antibiotics; but there's also new approaches such as the use of rapid diagnostics and the use of vaccines which have a potential impact to reduce the burden of drug resistant bacteria.

Our work makes a difference for patients in different ways. Some of the work can have a direct impact on patients, for example the work doing randomised control trials. If we can find effective interventions, those can be applied and rolled out. The pathway to having an impact for patients is a bit longer term. We also do work on improved methodology for randomised control trials and also work to really understand the biological mechanisms driving the spread of infections and driving in particular the spread of drug resistant bacteria. That can include for example mathematical modelling, to understand how bacteria spreads in hospitals, in the community, but also what happens to bacteria in people's guts when they take antibiotics as well.

This line of research matters because the global burden of infectious diseases is huge. In particular, antimicrobial resistance is one of the biggest global health problems we have, and it's forecasted to get much worse unless we develop effective interventions. And to develop effective interventions really needs funding because it takes a lot of work. There are a lot of steps in developing effective interventions which includes designing effective trials, carrying out those trials and also doing the analysis that can lead to those interventions being actually deployed.

This interview was recorded in July 2024.