ARCH at ECCMID 2020, Paris

ARCH Network’s abstract “Bridging the gap between human and animal antimicrobic resistance and consumption surveillance data, antibiotic policy and stewardship: the EPI-Net and ARCH projects” has been accepted for a poster  presentation at the upcoming ECCMID conference in Paris. More details on the session will follow in due time:

https://www.eccmidlive.org/

A translational approach to bridge the gaps between surveillance and antimicrobial stewardship

On 24-25 October, the JPIAMR projects ARCH (bridging the gap between humAn and animal on suRveillance data, antibiotic poliCy, and stewardsHip) and GAP-ON€ (Global Antimicrobial Resistance Platform for ONE Burden Estimates) organised a joint workshop in Verona, bringing together 40 experts from 12 different countries.

For the ARCH group, the discussions focused on reaching consensus on the proposed evidence-based recommendations on how to link and report surveillance data on resistance and antibiotic usage to antimicrobial stewardship teams in four target settings: hospitals, long term care facilities, community and veterinary.

The statements had been elaborated prior to the meeting following an extensive review of the literature (189 documents included) and preliminary expert consensus by means of an on-line survey (RAND-modified Delphi). The two-day meeting allowed experts to consider the proposals in detail and with the benefit of the perspective of epidemiologists, economists, veterinarians, infectious disease specialists, microbiologists and, experts in antimicrobial stewardship and antibiotic usage, all sitting together in the same room.

Work is now underway for the further and final revision of the statements and for the drafting of the four “Bridge the Gap: Survey to Treat” white papers into which the statements will be embedded and which are due to be published in a supplement dedicated to surveillance and stewardship in the Journal of Antimicrobial Chemotherapy.

This “Bridge the Gap: Survey to Treat” white paper series aims to improve reporting and clinical applicability of AMR and AMU surveillance data and to strengthen multidisciplinary cooperation in a One Health perspective. The feasibility of the recommendations will also be revised and optimized according to the heterogeneous economic settings including low and medium income countries and contexts lacking expertise in surveillance and stewardship.

The Verona meeting marks the beginning of a lasting collaboration among these multidisciplinary groups and across the two JPIAMR projects-ARCH and GAP-ON€  with a shared vision of the One Health perspective


Progress against project objectives

Since its inception in April 2019, several tasks were set in motion towards building the ARCH network, and development of the “Bridge the Gap: Survey to Treat” White paper series and a strategic research agenda. Here are some of the highlights:

Framework

Upon project launch, a proposal for the organisation of participants into 4 working groups (WG) according to their specific background and expertise was circulated and subsequently accepted by all with some minor adjustments. For each WG, a chairperson and a co-chairperson was nominated to lead the work of the respective WGs. An EPI-Net team member was also assigned to each WG to support the chairperson and co-chairperson in their work and to ensure synergies. Thereafter, a framework document outlining:   the agreed working group composition, a list of networks represented by the experts, the research strategy including a preliminary timeline with a description of roles and responsibilities, as well as a publication policy, was submitted to participants for comment and approval. This document provided the overall framework to ensure harmonisation of the work across the WGs and laid the groundwork for the subsequent elaboration of the scientific protocol for the White Papers.

Bridge the Gap: Survey to Treat” White paper series

Scientific protocol

To develop recommendations on how surveillance of antimicrobial use and antimicrobial resistance rates should be reported to drive antibiotic stewardship in the four target settings (hospitals, ambulatory, veterinary and long-term care facilities) a strategy involving evidence-based consensus was agreed upon. A draft protocol describing the key research questions under which recommendations are to be provided, steps in literature search and data extraction for evidence generation, and methodology for consensus was shared among all participants. Based on the comments and feedback the protocol was revised and finalized.

Evidence synthesis

A comprehensive literature search with the aim of selecting available evidence (studies, guidelines and recommendations) was undertaken. As a first step, national and international reports listed in the EU-JAMRAI repository on guidelines, tools and implementation methods for antibiotic stewardship in various settings were screened. The search was further expanded to PubMed database and Google search engine to identify additional literature using tailored search terms. When a document matched the inclusion criteria, data related to the research questions on antimicrobial stewardship team composition and legal framework, antibiotic resistance and antibiotic consumption were extracted. The data collected were collated to develop a summary report on literature evidence and identify key research gaps (research questions for which no literature evidence was available) and to compile a first draft of recommendations and research priorities. An online survey module to obtain the first round consensus in a two round RAND-modified Delphi method is currently being developed. Once this survey is on-line, ARCH members will be able to cast their votes and opinions on the draft recommendations (guided by literature evidence). Face-to-face group discussions at the upcoming ARCH/GAP-ONE joint meeting 24th October-25th October 2019 in Verona, Italy will help achieve the final round of consensus.

Strategic Research Agenda

To define strategic research agendas (SRAs) for future research focus and funding, several tools and techniques are currently available. In order to obtain an overview of the wealth of information that can guide priority setting exercises, it was decided that a rapid state-of-the-art review of grey and published literature (2018, 2019) will be performed. A total of 206 hits composed of guideline documents, opinion/review articles and research agendas were screened, and a detailed report summarizing recommendations and trends in health and healthcare research priority setting was shared with all the members. A checklist based on nine elements of good practice was also established to clarify the steps necessary for the creation of SRA. Further work on the SRA will be deliberated based on the results of the web-based survey and  face-to-face group discussions at the upcoming ARCH/GAP-ONE joint meeting.

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Upcoming: GAP-ONE and ARCH network joint workshop

A joint workshop convening members of the ARCH Net and GAP-ONE for development of the “Bridge the Gap: Survey to Treatwhite paper series will be held at the Villa Quaranta in Verona, Italy from 24.10.19 till 25.10.19. This workshop brings together experts from 19 nations who will work towards a One Health approach to bridge the gap between antibiotic resistance surveillance, stewardship and policy and to identify all elements that contribute to the high costs of AMR infections in a One Health perspective. Download preliminary agenda here

Image credit: Andreas Tille (Creative commons)

Joint efforts strengthening network goals

In the fight against antimicrobial resistance there is an increasing need for global collaborative efforts for development and implementation of ideas unhindered by borders and socio-economic conditions.  In keeping up with this necessity, the ARCH network has established strong partnerships to create a series of recommendations on reporting antimicrobial use and antimicrobial resistance rates to drive antibiotic stewardship, the “Bridge the Gap: Survey to Treat” White paper series. We are very happy to introduce our collaborators:

GAP-ONE

A JPIAMR Virtual Research Institute (VRI), the Global Antimicrobial resistance Platform for ONE Burden Estimates, GAP-ONE, network aims to create a virtual research environment able to:

  • Involve all stakeholders into a Network that will provide an opportunity for participants from different disciplines to interconnect more fully and effectively.
  • Identify all the data elements required to build a reliable tool for estimating resource waste due to AMR worldwide, not only in human health but also integrating veterinary and environmental data, within a One Health approach.
  • Provide a framework to assess data quality.
  • Devise a strategy for sharing currently available information.

Learn more

COMBACTE-MAGNET EPI-Net

Established under the IMI COMBACTE-MAGNET consortium of the New Drugs for Bad Bugs (ND4BB) programme, the epidemiology network (EPI-Net) is an unprecedented collaboration of experts in epidemiology and surveillance of healthcare-associated infections (HAIs) and antimicrobial resistance (AMR). EPI-Net engages representatives from major European Union financed projects and industry towards its objectives:

  • Optimize surveillance of a resistance and healthcare associated infections
  • Develop a consensus programme to contribute to the homogenization of the approach on current and future epidemiologic surveillance strategies in Europe
  • Inform Public Health Action
  • Support and guide R&D for new, effective antibiotics against antibiotic-resistant bacteria

Learn more

EARS-Vet

A European Joint Action on AMR and Healthcare Associated Infections (EU-JAMRAI) initiative to check feasibility of setting up a European surveillance network of AMR in diseased animals (EARS-Vet). The specific objectives of the project include:

  • Assess existing surveillance systems of AMR in animal pathogens in member states (MS) of Europe
  • Identify the main gaps and appropriate strategies for AMR surveillance in diseased animals in Europe depending on MS specificities
  • Assess the opportunities to combine MS surveillance systems into a pilot EU network for the surveillance of AMR in clinical animal isolates
  • Identify laboratory and technical capacities in MS for potential establishment of a molecular based AMR national surveillance of relevant resistant pathogens
  • Provide global and specific recommendations to EU to build a European network covering AMR surveillance in diseased animals, including interface with AMR surveillance in human medicine (SURVEILLANCE MANUAL)

Learn more

Image credit: Uni Cape Town (Creative commons)

JPIAMR publishes an updated Strategic Research Agenda

JPIAMR has published an updated version of its “Strategic Research Agenda” outlining priority research and innovation objectives to meet the needs of an One Health approach to tackle antimicrobial resistance (AMR) on a global scale. These research priorities outlined in the SRA are aimed at offering guidance to funding agencies, policy makers and others stakeholders working towards international initiatives to combat AMR.

The first edition and the updated version of the SRA are available for download