WHOLE GENOME SEQUENCING IN UNDERSTANDING ANTIMICROBIAL RESISTANCE - A FOCUS ON CARBAPENEM-RESISTANT PSEUDOMONAS AERUGINOSA AND ENTEROBACTERALES

Abstract

Antimicrobial resistance (AMR) is a major public health concern. The diversity and dynamicity of resistant pathogens can present complexities in the management of these infections. Unfortunately, there is a paucity of contemporary published data about the genomic epidemiology of these pathogens in Singapore. This thesis exploited the capacity of whole genome sequencing (WGS) to expound the phylogeny, clonality, resistance and virulence determinants, and mobile genomic elements of carbapenem-resistant <i>Pseudomonas aeruginosa</i> and Enterobacterales (in particular <i>Klebsiella pneumoniae</i>) isolated at a large, tertiary public health hospital in Singapore over a 15-year period. Here, WGS augmented conventional phenotypic surveillance to advance our understanding of AMR in key pathogens in the Singapore context. The rich repository of genomic and phenotypic data established here form a baseline reference database which serves to identify emerging public health threats and corresponding targeted control measures, inform treatment guidelines and future research priorities.