Director's Foreword

ARMRL's reference services include the confirmation of unusual resistances in bacteria, sent in by diagnostic laboratories in England and Wales. We advise on which antibiotics may remain as treatment options against multi-resistant strains, and can often test unusual or developmental agents. Reference molecular detection of key resistance genes is also undertaken. Through its reference activity ARMRL documented the first emergence of vancomycin-resistant enterococci worldwide, the first emergences of linezolid resistant enterococci in Europe, and the first emergence of acquired metallo-b-lactamases in the UK. ARMRL also undertakes sentinel surveys of resistance and has recently published data on the prevalence of resistance in gram-positive cocci from intensive care units, in Pseudomonas aeruginosa and in Acinetobacter spp. The British Society for Antimicrobial Chemotherapy's bacteraemia surveillance is sub-contracted to ARMRL, and we are major partners in GRASP -The Gonococcal Resistance to Antibiotics Surveillance Programme and EARSS - The European Antimicrobial Resistance Surveillance System. Through this surveillance activity we described the rise of MRSA in the UK and, more recently, the rapid accumulation of ciprofloxacin resistance in gonococci

ARMRL has a major research and development commitment, with 20-30 peer-reviewed papers published annually. Much of our research derives from our reference and survey activity, and involves the molecular investigation of unusually resistant bacteria. Increasingly, too, we are undertaking fundamental grant-funded research on the evolution of resistance, particularly on the role of hypermutators. Development is undertaken to improve methods for resistance detection. We provide advice to diagnostic laboratories on antibiotic testing and, within ARMRL, molecular detection of resistance genes is increasingly migrating to real-time PCR. In-vitro evaluations of new antibiotics of new antibiotics are undertaken, in collaboration with their developers. These studies provide ARMRL with early experience of new drugs, and provide the pharmaceutical company with access to collections of epidemiologically-diverse organisms with characterised resistance mechanisms.

ARMRL staff have a high profile, serving on numerous editorial and advisory boards, including the UK Government's Specialist Advisory Committee on Antibiotic Resistance. ARMRL communicates with its customers via a 6-monthly Newsletter, available via this website and as a print version.. This advises on (i) our service and how it should (& should not) be used, (ii) important national and international developments in resistance and (iii) detection of those resistances that often cause confusion/problems in diagnostic laboratories.