The Antimicrobial Resistance Research Unit (ARU), headed by Professor Essack as its Director, adopted the One Health approach, investigating antibiotic resistance in human, (food) animal and environmental health in keeping with the UN Political Declaration on Antimicrobial Resistance (AMR) and the associated Global Action Plan on AMR developed by the tripartite alliance of the World Health Organization (WHO), the Food and Agriculture Organization of the United Nations (FAO) and the World Organization for Animal Health (OiE).
In human health, the ARU has as its overarching objective the optimization of antibiotic therapy in the face of escalating resistance within a public health system facing an ever-increasing incidence of infections corresponding with the HIV/AIDS prevalence in the province of KwaZulu-Natal. This expanded to include the private health sector thereby addressing a critical gap in the knowledge on the nature and extent of antibiotic use and resistance in the private sector where antibiotic prescription is at the discretion of the clinician and not restricted to the essential medicines list.
The ARU investigates antibiotic resistance across the farm-to-fork continuum in intensive food animal production, specifically pigs and poultry. Soil fertilized by litter from food animals, and, surface, ground and potable water as well as influent and effluent from waste water treatment plants forms the environmental component of the research.
Research in the ARU encompasses the molecular epidemiology of antibiotic resistance and the delineation of resistance phenotypes and genotypes ranging from sensitivity testing to DNA sequencing and whole genome sequencing to delineate clonality, resistant and virulence genes and their associated mobile genetic elements. Resistance to b-lactam antibiotics, aminoglycosides, fluoroquinolones and macrolides is prioritised, as is resistance in the ESKAPE (Enterococcus faecium, S. aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter spp.) pathogens and Escherichia coli. Both the bacterial species and antibiotic classes have expanded as new and emerging resistance is detected e.g. carbapenem, colistin and tigecycline resistance in Enterobacteriaceae and macrolide and ketolide resistance in Haemophilus influenzae.
The ARU is committed to human capital development, creating a critical mass of PhD credentialed researchers and postdoctoral fellows in Africa with research knowledge and skills to generate evidence to optimally manage and contain antibiotic resistance in the One Health approach. The ARU hosts several postgraduate students from Africa (Cameroon, Ghana, Lesotho, Malawi, Mozambique, Namibia, Nigeria, Swaziland, Sudan and Zimbabwe) who explore antibiotic resistance in their country contexts.