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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