Solutions to overcome barriers

The issue

Surveillance of antimicrobial resistance (AMR) and antimicrobial use (AMU) is essential to all aspects of antibiotic prescribing and clinical management of patients. The key role played by surveillance starts with the development of algorithms for empiric antibiotic therapy and of stewardship programmes. Indeed, active monitoring of AMR and AMU is essential to effective antibiotic stewardship supporting appropriate antimicrobial use that optimises patients´ clinical outcomes while minimising unintended consequences of antibiotics, including toxicity and the emergence of resistance. Knowledge of up-to-date surveillance data improves public health not only at the local level (clinical outcomes for patients) but also globally (hospital and community). However the link between availability of surveillance data and antibiotic prescription is vague and fragmented.

Major limitations to bridge the gap between surveillance data and antibiotic policy are the significant heterogeneity in data reporting among different countries and within the same country and the poor connection between clinical prescribers and surveillance data providers. Of even more concern is the insufficient coordination of surveillance systems of human AMU and AMR resistance with animal surveillance systems resulting in uncoordinated efforts for antibiotic stewardship in human and animal populations and increase in the emergence and spread of resistance genotypes and phenotypes among compartments.  In this scenario, a global, translational approach linking, through evidence-based checklist, surveillance reports with stewardship team recommendations, would facilitate the interventions, ensure generalisability of the results, and contribute to a coordinated effort to reduce inappropriate antibiotic usage in animal and humans populations.

Bridge the Gap: Survey to Treat

Strengthened by translational approach, the ARCH Net aims to finalise a series of four white papers (deliverables D1.1-D1.4) tailored for different settings. The recommendations will be provided in the form of easy to read checklist (App format preferable), listing which microbiological data as well as which antimicrobial use data; and in which format are essential for antibiotic prescribing in different settings and how these data can be translated in antibiotic guidance and stewardship interventions. The network will also develop a strategic research agenda (deliverable D1.5) prioritising topics in need of funding. The members of the network have been assigned to five major working groups each targeting specific deliverables:

Working group 1: White paper recommendations, Hospitals

Objective: D1.1-Develop guidelines on reporting antimicrobial use and antimicrobial resistance rates to drive antibiotic stewardship in hospitalised patients (with dedicated checklists for medical and surgical wards, paediatric wards, and intensive care units)

Chair: Evelina Tacconelli
Co-chair: Marc Mendelson

Members: Thirumalaisamy P Velavan; Souha Kanj; Mike Sharland; Nico Mutters; Petra Gastmeier; Christian Giske; Lorena López-Cerero; Andreas Voss; Roberto Cauda; Luigia Scudeller; Andreas Widmer; Elisabeth Presterl; Jean-Christophe Lucet; Leonard Leibovici; Elena Carrara; Julia Bielicke; Gunnar Kahlmeter; Marcella Sibani; Liliana Galia

EPI-Net representative: Diletta Pezzani

Working group 2: White paper recommendations, Veterinary

Objective: D1.2-Develop guidelines on reporting antimicrobial use and antimicrobial resistance to drive antibiotic stewardship in veterinary care

Chair: Elena Mazzolini
Co-chair: Remco Schrijver

Members: Nico Mutters; Alex Friedrich; Luigia Scudeller; Maurizio Sanguinetti; Rodolphe Mader

EPI-Net representative: Monica Compri

Working group 3: White paper recommendations, Long term care facilities

Objective: D1.3-Develop guidelines on reporting antimicrobial use and antimicrobial resistance to drive antibiotic stewardship in long term care facilities

Chair: Andreas Voss
Co-chair: Nico Mutters

Members: Evelina Tacconelli; Christian Giske; Lorena López-Cerero; Luigia Scudeller; Andreas Widmer; Leonard Leibovici; Maurizio Sanguinetti; Siri Göpel; Rita Murri; Mical Paul; Gunnar Kahlmeter; Monica Compri; Fabiana Arieti

EPI-Net representative: Fulvia Mazzaferri

Working group 4: White paper recommendations, Ambulatory

Objective: D1.4-Develop guidelines on reporting antimicrobial use and antimicrobial resistance to drive antibiotic stewardship in ambulatory

Chair: Siri Göpel
Co-chair: Roberto Cauda

Members: Evelina Tacconelli; Ramanan Laxminarayan; Ayola Akim Adegnika; Souha Kanj; Mike Sharland; Herman Goossens; Petra Gastmeier; Alex Friedrich; Luigia Scudeller; Elisabeth Presterl; Theoklis E. Zaoutis; Rita Murri; Mical Paul; Elena Carrara; Julia Bielicke

EPI-Net representative: Fabiana Arieti

Working group 5: Strategic Research Agenda

Objective: D1.5-Identify critical areas and gaps prioritize studies to improve the evidence on the effectiveness of surveillance in reducing antibiotic usage

Chair: Marc Mendelson
Co-chair: Julia Bielicke

Members: Evelina Tacconelli; Ramanan Laxminarayan; Thirumalaisamy P Velavan; Ayola Akim Adegnika; Herman Goossens; Christian Giske; Remco Schrijver; Alex Friedrich; Luigia Scudeller; Andreas Widmer; Theoklis E. Zaoutis; Jean-Christophe Lucet; Elena Mazzolini; Rita Murri; Rodolphe Mader; Gunnar Kahlmeter

EPI-Net representative: Nithya Babu Rajendran

Impact on moving AMR Surveillance forward
  • The series of the ARCH White Papers will provide a very practical tool to connect surveillance data with stewardship guidance. The recommendations will be provided in practical checklist (available in electronic or paper form), easy to use also in settings with limited expertise in surveillance and antibiotic stewardship. Improved surveillance data to be provided to medical doctors will favourably impact hospital antibiotic usage. The recommendations will be provided in practical checklist (available in electronic or paper form), easy to use also in settings with limited expertise in surveillance and antibiotic stewardship. Improved surveillance data to be provided to medical doctors will favourably impact hospital antibiotic usage.
  • The dissemination of the results will increase homogeneity in data reporting, comparability of data and effectiveness of interventions and antibiotic policy.
  • The focus on high risk population as ICU will facilitate the antibiotic stewardship teams enabling appropriate assessment of the AMU and AMR rates to develop antibiotic policy recommendations in these settings, thus reducing antibiotic pressure and related morbidity and mortality. The model could be easily exported to other settings in the future as transplants or hematological patients.
  • The availability of checklist for the pediatric population will play a pivotal role in the implementation of antibiotic stewardship and in the measure of efficacy and outcomes indicators.
  • The One Health approach of the D1.3 focusing on surveillance in the animal population will promote and harmonize reporting in animal surveillance and stewardship. The panel will define which microorganisms in animal population need to be strictly followed up with the human population. The strict collaboration within the Net between multidisciplinary experts in human and animal population will foster exchange of data, collaborative projects and alignment of goals among the groups.
  • The checklists could be easily incorporated into existing and new national and international guidelines and algorithms to guide appropriate antibiotic use in LTCFs. In this setting the availability of clear indications on how to connect microbiological laboratories (usually far away from the healthcare) could help in connecting external microlabs with the prescribers and improve local antibiotics policy.
  • Although the highest consumption of antibiotics is reported in community there is no dedicated guidance on how general practitioners could assess and use surveillance data to reduce inappropriate antibiotic usage. The checklist could also play a role in community campaigns to improve appropriateness of prescriptions.
  • The strategic research agenda will identify critical areas and gaps and prioritize studies to improve the evidence on the effectiveness of surveillance in reducing antibiotic usage. The document could be also used by research institutions providing funding for AMR research.

Mode of operation

The ARCH Net will operate (primarily) remotely with regular communications facilitated by web-based tools. The white papers and research agenda will be developed by each working group in this fashion. A two-day workshop will bring together all the network members to facilitate review, face-to-face discussions and drafting of the white papers. Based on the results of these discussions and white paper drafts, the creation of a research agenda will commence. Following review and final approval from the members, an open consultation will be sought through ARCH Net-associated networks and international stakeholders for finalization of deliverables D1.1-D1.5.

Key protocols developed during this process, results and outcomes will be published regularly through this website, national meetings, international conferences, and scientific journals. To obtain latest updates on the project progress, subscribe to ARCH-Net’s quarterly newsletter.