Bridging the gap between humAn and animal suRveillance data, antibiotic poliCy, and stewardsHip



Research Network: 2019-04-01 - 2020-12-31
Total sum awarded: €50 000

Surveillance is essential to all aspects of the clinical management of antimicrobial resistance. It provides necessary information to develop empiric therapy guidelines, antibiotic formularies, and stewardship programmes. However, the value of surveillance as a critical component of antimicrobial stewardship is not fully established and the majority of the guidance documents focuses either on laboratory surveillance or antibiotic guidelines. The ARCH Network uniquely brings together multisectoral specialists and networks in the field of animal and human surveillance to bridge the gap between surveillance data and antibiotic stewardship in both compartments. The group will finalise four white papers (“Bridge the Gap: Survey to Treat”) tailored to: hospitals (medical and surgical wards, paediatric clinic, intensive care units), long term care facilities, out-patients ambulatory, and veterinary care. The white papers will be developed in the form of checklists (App and paper forms) summarising the kind of microbiological and antimicrobial use data that are essential for antibiotic prescribing, and how these data relate to antibiotic guidance and stewardship interventions. The multidisciplinary group will integrate recommendations for the checklist implementation in heterogeneous economic settings and where expertise in surveillance is limited. The ARCH Network will organise two one day workshops and will be operating through Webex meetings and conference calls. During the first workshop, the group will discuss opportunities for data sharing, other networks involvement, website features, and define the milestones and tasks´ timeline. The drafts of the white papers will be available for open consultation to ARCH members and through the associated networks (EUCIC, EPI-Net, ResistanceMap, LOTTA, EUCAST, LAB-Net, KISS, HANNET, Global PPS, AMCLI-COSA, SWISS-NOSO, CLEO) and international stakeholders (ECDC, WHO, Wellcome, EMA). The ARCH experts will also develop a strategic research agenda to identify critical areas and gaps in clinical surveillance. In the second workshop white papers and the strategic research agenda will be reviewed and approved. The dissemination will be pursued in the dedicated website, quarterly newsletter, national and international conferences, publications in open scientific peer reviewed journals and though relevant national societies in the field. The ARCH Network will also develop a plan for the sustainability of the network after the funding period.

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  • Evelina Tacconelli, University Hospital Tübingen, Germany (Coordinator)
  • Thirumalaisamy P Velavan, Vietnamese-German Centre for Medical Research, Vietnam (Observer)
  • Ayola Akim Adegnika, Centre de Recherches Médicales de Lambaréné, Gabon (Observer)
  • Souha Kanj, American University of Beirut Medical Center, Lebanon (Observer)
  • Marc Mendelson, University of Cape Town, South Africa (Observer)
  • Mike Sharland, St George's University of London, United Kingdom (Observer)
  • Herman Goossens, University of Antwerp, Belgium (Observer)
  • Nico Mutters, University Hospital Bonn, Germany (Observer)
  • Petra Gastmeier, Charité University Medicine, Germany (Observer)
  • Christian Giske, Karolinska University Hospital, Sweden (Observer)
  • Lorena López-Cerero, University Hospital Virgen Macarena, Spain (Observer)
  • Andreas Voss, Radboud University Medical Centre, Netherlands (Observer)
  • Roberto Cauda, IRCCS Fondazione Policlinico Universitario A. Gemelli, Italy (Observer)
  • Remco Schrijver, VetEffecT, Bilthoven, Netherlands (Observer)
  • Luigia Scudeller, IRCCS Fondazione Policlinico San Matteo, Italy (Observer)
  • Elisabeth Presterl, Medical University of Vienna, Austria (Observer)
  • Jean-Christophe Lucet, Claude Bernard Hospital, France (Observer)
  • Leonard Leibovici, Rabin Medical Center, Israel (Observer)
  • Maurizio Sanguinetti, IRCCS Fondazione Policlinico Universitario A. Gemelli, Italy (Observer)
  • Julia Bielicki, St George's University of London, United Kingdom (Observer)
  • Steffen Borrmann, University Hospital Tübingen, Germany (Observer)
  • Giulia De Angelis, Catholic University of Rome, Italy (Observer)
  • Raquel Duro, Centro Hospitalar Universitário de São João, Portugal (Observer)
  • Maria-Eleni Filippitzi, Department of Epidemiology and Public Health, Sciensano, Belgium (Observer)
  • Isabel Frost, Center for Disease Dynamics, Economics & Policy, India (Observer)
  • Siri Göpel, University Hospital Tübingen, Germany (Observer)
  • Luca Guardabassi, University of Copenhagen, Denmark (Observer)
  • Annet Heuvelink, Royal GD, Netherlands (Observer)
  • Jobke van Hout, Royal GD, Netherlands (Observer)
  • Gunnar Kahlmeter, Växjö Central Hospital, Sweden (Observer)
  • Tomislav Kostyanev, University of Antwerp, Belgium (Observer)
  • Rodolphe Mader, ANSES, French Agency for Food, Environmental and Occupational Health & Safety, France (Observer)
  • Elena Mazzolini, Istituto Zooprofilattico Sperimentale, Italy (Observer)
  • Rita Murri, IRCCS Fondazione Policlinico Universitario A. Gemelli, Italy (Observer)
  • Mical Paul, Technion Israel Institute of Technology, Israel (Observer)
  • Hanna Renk, University Hospital Tübingen, Germany (Observer)
  • Oana Sandulescu, University of Medicine and Pharmacy, Bucharest, Romania (Observer)
  • Le Huu Song, Vietnamese-German Centre for Medical Research, Vietnam (Observer)
  • Didem Torumkuney, International Federation of Pharmaceuticals and Manufactures & Associations (IFPMA), Geneva, Switzerland (Observer)

Among the factors that play a role in the alarming increase of antimicrobial resistance (AMR), misuse of antibiotics in both human and veterinary sectors is the most important catalyst. Prescribing antibiotics for viral infections, usage of antibiotics in meat production, self-medication, etc., are some examples of inappropriate use of these life-saving drugs. Once a bacterium develops resistance to an antibiotic, it loses its potential to kill the bacterium; hence infections caused by the bacterium cannot be treated. Considering that it is very difficult to develop new antibiotics, it is crucial to preserve the efficacy of antibiotics by promoting their prudent use through education and strong regulations. Antimicrobial stewardship (AMS) is a regulatory program, which if performed in places where antibiotics are prescribed, can ensure their sustainability. AMS involves tracking the amount of antibiotics used (AMU) and frequency of occurrence of AMR (how many patients had a bacterium resistant to an antibiotic) to define a set of actions to improve the standards of AMU and bring down AMR and to educate staff (clinicians, nurses, pharmacists, etc.) performances. Although AMS has been in practice for over 20 years, guidance on how to perform AMS has been tailored to hospitals mostly and lacks details on surveillance of AMU and AMR for stewardship purposes. But with the recognition that AMR can only be tackled by addressing the antibiotic misuse in multiple sectors, including veterinary, a need for more comprehensive practical “One Health” recommendations has risen. JPIMAR’s ARCH Network brought together multidisciplinary experts in the field with the aim of developing easy-to-use recommendations (checklists) to promote and help customize AMS programs in four highly relevant settings: hospitals, general practices, elderly homes and veterinary clinics. The checklists would indicate detailed answers to three primary questions: “how to build and lead a team to oversee and execute actions under the AMS program?”, “how to perform surveillance of AMR?”, and “how to perform surveillance of AMU?” To develop the four checklists, an extensive search of current literature was performed to generate “evidence” with which a draft of answers in the form of action items were developed by a research team. The evidence and the draft were presented to the experts who evaluated the action items via an online survey followed by a two-day face-to-face meeting. Through this consensus process the checklists were finalized. For those questions for which no answers could be generated or those answers for which no consensus was achieved indicated serious gaps in the current scientific knowledge and were deemed as “research priorities” in need of immediate attention. We thus developed a very flexible, practical One Health tool with the potential to drive implementation of AMS and improve surveillance of AMR and AMU for a holistic strategy to preserve antibiotics.