The Antimicrobial Resistance in Intensive Care (AMRIC) Network: A global surveillance network to monitor the role of the ICU environment in the emergence of AMR
The intensive care unit (ICU) treats the most seriously ill patients in the contemporary health care system. Because of pre-existing illnesses and a high prevalence of infection - both as an admitting diagnosis and as a complication of ICU care – up to 75% of ICU patients are exposed to antibiotics during their ICU stay, and colonization or infection with resistant organisms is common. Patterns of resistance vary strikingly around the world, however, suggesting that there are potentially modifiable factors that can be targeted to minimize the emergence of resistance. We will leverage the collective resources of the International Forum for Acute Care Trialists (InFACT), a global network of close to 30 organizations that conduct investigator-led research into the optimal care of critically ill patients, to design a geographically representative surveillance program to track antimicrobial resistance in ICUs around the world, and to identify environmental and practice-dependent risk factors that are amenable to change. During this initial phase of the program we will conduct a scoping review to identify key data elements to include in this surveillance program, and to determine the simplest and most costeffective manner of capturing key data. In collaboration with InFACT programs to map global capacity for critical care, to define the denominator in international prevalence studies, and to define the incidence of severe acute respiratory infection treated within the ICU, we will develop a pilot network of ICUs to launch the Antimicrobial Resistance in Intensive Care (AMRIC) network. Finally we will use the data from these initial activities to develop a business plan and to seek long term sustainable funding. The global challenge of antimicrobial resistance requires global solutions. By addressing the impact of a venue within the health care system that is a major user of antibiotics and a key reservoir of resistant organisms, and ultimately doing so on a comprehensive international level, we seek to support efforts to address a major health challenge of the 21st century.
- John Marshall, University of Toronto, Canada (Coordinator)
- Rob Fowler, University of Toronto, Canada (Observer)
- Nick Daneman, University of Toronto, Canada (Observer)
- Srinivas Murthy, University of British Columbia, Canada (Observer)
- Anthony Gordon, Imperial College London, United Kingdom (Observer)
- Michael Bauer, Friedrich-Schiller-University, Germany (Observer)
- Miguel Sánchez García, Universidad Complutense de Madrid, Spain (Observer)
The development of potent antibiotics has enabled the unprecedented survival of patients with life-threatening bacterial infections. However bacteria are able to develop resistance to these antibiotics (antimicrobial resistance, or AMR), with the result that over time, their effectiveness is lost. Many experts believe that we are facing a crisis: the loss of antibiotics as a therapy for infection because of the rapid development of AMR. Nowhere in the health care system is the concentration of patients with serious infection, and therefore the widespread use of antibiotics higher than in the intensive care unit. On a given day, half of all ICU patients are infected, and ¾ are receiving antibiotics. The ICU is a breeding ground for resistance, but also a powerful but under-used resource to study the factors that drive resistance. It is recognized that both the organisms that cause infection in critically ill patients and their sensitivity to antibiotics differ in differing parts of the world, suggesting that there are modifiable factors underlying these differences. The Antimicrobial Resistance in Intensive Care (AMRIC) program seeks to develop a global, ICU-based surveillance network that will use international variability in patters of infection and resistance to identify factors that promote resistance and to design programs to limit these. AMRIC builds on an international network of ICU-based research networks – the International Forum for Acute Care Trialists (InFACT). We have identified country leads in 22 countries on every continent, and are completing analyses of global capacity and needs for such a study, as well as modeling its potential utility by pooling published data. We have further developed collaborative funding applications and a program to evaluate the role of ICU water sources in serving as a reservoir for resistant organisms.