School of Infection & Immunity

Professor Nicholas Feasey

  • Sir James Black Professor of Infection Medicine (University of St Andrews)
  • Location: Room 103A, Clarice Pears Building

Title: Drivers of Antimicrobial Resistance in Uganda and Malawi

Synopsis:

Antimicrobial resistance (AMR) is a major threat to human health, predicted to impact most heavily on sub-Saharan Africa, where clinical outcome data remain limited. We established prospective longitudinal cohorts at Queen Elizabeth Central Hospital, Blantyre, Malawi, and surrounding communities to investigate febrile illness, AMR and the distribution of extended-spectrum beta-lactamase (ESBL)-producing Enterobacterales.

Among 225 patients presenting with febrile illness, 67% were living with HIV and a diagnosis was identified in 64%, most commonly tuberculosis (34%), invasive bacterial infection (17%), arboviral infection (13%) and malaria (9%). In a second cohort, third-generation cephalosporin resistance was associated with increased in-hospital mortality (HR 1.44, 95% CI 1.02–2.04), longer hospitalisation and reduced probability of discharge alive (HR 0.31, 0.22–0.45). ESBL-Enterobacterales were widespread in the community, occurring in 41.8% of human stool, 29.8% of animal stool, 66.2% of river water and 46.0% of drain water samples. Genomic data suggests transmission between human animal and the environment.

Life-threatening febrile illness is common but diagnostic capacity remains limited, making empirical ceftriaxone use rational but frequently ineffective. Drug-resistant infection causes substantial excess morbidity and mortality, while ESBL-producing E. coli and K. pneumoniae are ubiquitous across hospital, community and environmental reservoirs. Improved diagnostics, optimised sepsis management, sanitation and community antimicrobial stewardship are urgently needed.

Bio: 

Nicholas Feasey is the Sir James Black Professor of Infection Medicine at St Andrews University, Professor of Microbiology at Liverpool School of Tropical Medicine and an NIHR Professor of Global Health. He is a Clinical Microbiologist and Infectious Diseases physician, currently working as honorary consultant microbiologist at NHS Fife, and has previously held honorary positions at The Royal Liverpool University Hospital (Infectious Diseases) and Queen Elizabeth Central Hospital, Blantyre, Malawi (Senior Physician). His research is focused on the surveillance and management of antimicrobial resistant bacterial infection and taking a one health approach to preventing the transmission of enteric pathogens. His current focus is on reducing Healthcare Associated Infections by developing an Infection Prevention and Control programme in the Southern Region of Malawi. 

First published: 12 August 2026

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