We spoke to Dr Libby Graham, Diagnostic Laboratories Manager, who joined the RVC in June 2025. This is an extended version of an article that appeared in the Autumn 2025 issue of Clinical Connections. 

Please give a precis of your career trajectory.   

Following a brief period in companion animal practice, I returned to university to pursue a long-held interest in veterinary immunology and infectious disease. My PhD on the host immune response to feline leukaemia virus (FeLV), at Glasgow’s School of Veterinary Medicine, was followed by a postdoctoral project in bovine immunology and tuberculosis at the Institute for Animal Health.

I spent the next 10 years in Glasgow, where I was involved in the diagnostic service, undergraduate teaching and clinical research, before relocating with my family to New Zealand. There, I joined a contract research group, Cognosco, where we undertook field trials and research projects in bovine mastitis and infertility. One of our most interesting projects involved implementing a national bulk milk tank antimicrobial susceptibility testing service.

I returned to the UK in 2018 as the Director of an expanding private veterinary diagnostic laboratory service (now Medivet Labs) before moving to Antech Diagnostics. I was part of the operational team that managed their first expansion into Europe, in 2022. I joined the RVC in June 2025.

What made you decide to specialise in veterinary microbiology?   

As an undergraduate, I found microbiology particularly fascinating. Microorganisms constantly evolve and adapt to their environment, and the advancement of new technologies continually challenges our understanding and knowledge. The innovative technologies and the potential for ongoing discovery make this an exciting and inspiring subject.

How has your experience as a vet helped you to help clients?   

My experience in veterinary practice has helped me focus on the patient. In the diagnostic laboratory, we work with data and specimens, so it helps to visualise the patient and their concerned owners. When we experience near-miss or deviation events in the laboratory, we always consider and record the potential impact on the patient.

As a new graduate, I didn’t fully appreciate the depth of resources available in our diagnostic laboratories and didn't use their expertise enough. I would like our veterinary clients to know that our technical and veterinary staff are accessible and available to support them with their cases.

What key changes have you observed in the field since you began your career?   

In recent years, I have witnessed a long-overdue focus on the veterinary clinical microbiology laboratory. This has been driven by the emerging threat of antimicrobial resistance (AMR) and an acknowledgement of the critical role that laboratories can play in supporting effective antimicrobial stewardship at the patient level, as well as in providing data for national and international AMR surveillance. These surveillance networks provide information critical to the development of treatment guidelines, antimicrobial stewardship programmes, and public health interventions.

The veterinary clinical microbiology laboratory, however, has faced several challenges in meeting these responsibilities, including a lack of standardised methodologies, a shortage of veterinary-specific clinical breakpoints, and a lack of subject-specific expertise. It is encouraging to know, however, that recent developments in the UK and across Europe have begun to address these issues.

A timely initiative in the UK led by Dr Fergus Allerton has facilitated closer collaboration between veterinary clinical microbiology laboratories through ongoing and well-supported CPD meetings. This initiative has progressed to the formation of a new society, Veterinary Laboratory Antimicrobial Diagnostics (VLAD).

A new project surveying antimicrobial resistance in companion animal specimens submitted to UK diagnostic laboratories was launched this year. Led by Professor Dorina Timofte and funded by the Veterinary Medicines Directorate, the project also aims to standardise methods for bacterial culture, resistance, and susceptibility testing. This will enable data at the laboratory level to feed into other cross-border initiatives, such as the European AMR Surveillance Network in Veterinary Medicine (EARS-VET).

Since beginning my career, new opportunities have emerged for both veterinary surgeons and scientists to obtain specialist postgraduate qualifications in veterinary microbiology. Ten years ago, I collaborated closely with colleagues across Europe to establish a new specialist college, the European College of Veterinary Microbiology (ECVM), to train and certify veterinary graduates in microbiology. Today, the College has 44 residents in training centres across Europe. The Royal College of Pathologists has also established a training programme and qualification for both veterinary surgeons and scientists in veterinary microbiology (FRCPath).

What attracted you to the RVC and what does your role entail?

This role at the RVC was an excellent opportunity to build upon the currently successful diagnostic laboratory service, particularly considering my strategic and operational experience in the private sector.

I was also keen to return to an academic environment, with the possibility of collaborating on clinical research projects in infectious disease. Additionally, with my interest and specialist knowledge in veterinary microbiology, I anticipated opportunities to enhance the current diagnostic service in infectious disease by exploring innovations in testing.

I am involved in the day-to-day operational management of the RVC Diagnostic Laboratories. My focus, in line with our overall clinical strategy, is to introduce and embed the most efficient and quality-focused practices that I have experienced throughout my career. I also need to stay alert to opportunities to be at the forefront of new technologies.

I am keen that our laboratory adopts a collaborative approach to supporting both basic and clinical research endeavours, to the benefit of animal welfare. I am also committed to supporting the development and growth of our laboratory team within a healthy and supportive working environment.

How do you see the veterinary microbiology field evolving in the coming years?

Focusing again on AMR, I look forward to the establishment of integrated surveillance systems to support a One Health approach in addressing the threat of AMR.

In the veterinary clinical microbiology laboratory, the adoption of new technologies and platforms to identify microorganisms and/or generate quantitative susceptibility results has created some labour and time savings. Still, it hasn’t yet been possible to move away from the need to first culture the test organism(s) from clinical specimens. A typical turnaround time for a straightforward culture and susceptibility (C&S) result is two days from the time the specimen arrives at the test laboratory, and likely three days since sampling.

An essential and achievable target in veterinary microbiology should be the rapid delivery of susceptibility and resistance results at the point of care (POC) to support the timely initiation of appropriate therapy and monitoring of the treatment response. POC methods that use simple and rapid isothermal amplification reactions to identify resistance genes in clinical specimens are already becoming available. Ongoing advances in microfluidics and biosensor technologies have additional potential to generate future effective and quantitative POC systems.

Back in the centralised laboratory, routine diagnostic methods are likely to evolve away from traditional culture to be replaced by metagenomic sequencing techniques. This involves screening the genetic material within clinical specimens to identify pathogens, resistance, and virulence mechanisms. The technology is not yet a practical routine option due to the requirement for significant computational analysis, high setup costs, and challenges in interpretation, but it is likely to replace traditional culture methods in the future.