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
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.
A joint workshop convening members of the ARCH Net and GAP-ONE for development of the “Bridge the Gap: Survey to Treat” white 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
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.
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
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)
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
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