Becoming an Expert: Andrew Swale

andrew swale

Over the past decade, Clostridium difficile has become a major cause of illness in hospitals, killing tens of thousands of people worldwide every year.

Despite the importance of this so-called ‘superbug’ in modern medicine, however, relatively little is known about how the bacterium interacts with its human hosts.

Postgraduate student Andrew Swale, from the University of Liverpool’s Institute of Translational Medicine, is hoping to contribute to solving this problem.

C. difficile-associated infections can take hold when prescribed antibiotics reduce the number of naturally occurring bacteria in patients’ guts. Given its resistance to the majority of antibiotics and the reduced competition it then faces, the superbug is more easily able to reproduce and cause disease.


Symptoms can range from mild diarrhoea to fatal systemic inflammation, with 20 to 40% of patients relapsing after their initial infection.

A number of studies have recently improved understanding of the bug and how it spreads. This, combined with improved hygiene in hospitals, has led to a decrease in the number of cases in the UK.

Andrew, who graduated with a degree in genetics from Liverpool before beginning his PhD with supervisor Professor Munir Pirmohamed, said: “More than 1,500 patients in England and Wales, however, still died as a result of C. difficile infections in 2012 alone. We believe that looking at the bug itself is too limited and that more research investigating its molecular interactions with its hosts is urgently needed.

“Diseases and the microbes that cause them are often characterised by specific molecules, pathways and genes, known as ‘signatures’. Identifying certain combinations of these signatures can allow us to predict the course and outcome of a disease.

”In the case of C. difficile, this could mean preventing life-threatening infections, relapses and costly hospital readmissions.”

“In the case of C. difficile, this could mean preventing life-threatening infections, relapses and costly hospital readmissions.

“One of the key areas of my research concerns the three major toxins released by epidemic strains of C. difficile. The toxins are the main cause of the disease so our goal is to identify which signatures play a role in the host’s immune response when faced with them in potentially serious cases.


“Whilst this technique is nothing new, our method is more sensitive and is the first to be able to profile the response against all three C. difficile toxins”.

“We believe that, if doctors are able to diagnose a patient’s risk of contracting a severe infection early on, using tests such as this, then they can treat it before it becomes too serious.

“This will allow hospitals to prioritise those patients most at risk and could decrease the average length of stay in hospital, which will, in turn, decrease the burden on the healthcare system.”

Andrew Swale

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