R-GNOSIS

Resistance in Gram-Negative Organisms: Studying Intervention Strategies

 Partecipanti

Mappa

 Word cloud

Esplora la "nuvola delle parole (Word Cloud) per avere un'idea di massima del progetto.

 Obiettivo del progetto (Objective)

'Antibiotics are a mainstay of public health, but their use has increased exponentially leading to the emergence of antibiotic resistance. The R-GNOSIS (Resistance in Gram-Negative Organisms: Studying Intervention Strategies) project combines 5 international clinical studies, all supported by highly innovative microbiology, mathematical modelling and data-management, to determine - in the most relevant patient populations - the efficacy and effectiveness of cutting-edge interventions to reduce carriage, infection and spread of Multi-Drug Resistant Gram-negative Bacteria (MDR-GNB). All work-packages will progress science beyond the state-of-the-art in generating new and translational clinically relevant knowledge, through hypothesis-driven studies focussed on patient-centred outcomes. The 5 clinical studies will investigate the following interventions: •A Point-Of-Care-Testing guided management strategy to improve appropriate antibiotic prescription for uncomplicated UTI in primary care. •Gut decolonization in outpatients with intestinal carriage of MDR-GNB. •A “test and prescribe” strategy, based on rapid diagnostic testing of faeces for MDR-GNB to optimize antibiotic prophylaxis in colo-rectal surgery. •Contact Isolation of patients with ESBL-producing Enterobacteriaceae in general hospital wards. •Three Decolonization strategies in ICUs. Seven laboratories across Europe will perform microbiological analyses, as well as unique quantitative experiments. All information will be integrated by 3 groups of mathematical modellers into highly innovative models to better understand and predict future trends and effects of interventions. The studies and analyses proposed in R-GNOSIS will generate a step-change in identifying evidence-based preventive measures and clinical guidance for primary care and hospital-based physicians and health-care authorities, to combat the spread and impact of infections caused by MDR-GNB in Europe.'

Introduzione (Teaser)

Five European studies are working to revolutionise screening and treatment practices in healthcare settings and primary care to minimise transmission of drug-resistant bacteria.

Descrizione progetto (Article)

Over the past years, the injudicious use of antibiotics has led to a dramatic increase in the emergence of drug resistance. According to European health authorities, multi-drug resistant gram-negative bacteria (MDR-GNB) infections resulted in thousands of deaths and millions of hospitalisations. These statistics illustrate the urgent need of developing novel strategies for minimising the emergence and transmission of resistant microbial species.

The EU-funded http://www.r-gnosis.eu/ (R-GNOSIS) (Resistance in gram-negative organisms: studying intervention strategies) project is assessing the efficacy and effectiveness of cutting-edge interventions in reducing MDR-GNB transmission through five international clinical intervention studies.

The first of these studies entail the development of a point-of-care-testing strategy for diagnosing uncomplicated urinary tract infection to improve the overall management of antibiotic prescription. The efficacy of another rapid diagnostic test is being assessed for the detection of MDR-GNB in faeces as a means of providing antibiotic prophylaxis in colorectal surgery.

In a trial with patients carrying intestinal MDR-GNB, R-GNOSIS proceeded with decolonisation using high concentrations of topical antibiotics and subsequent gut recolonisation with faecal microbiota. This procedure has already shown efficacy against recurrent infections with Clostridium difficile and this approach is now being pursued in patients carrying MDR-GNB.

During an international trial in 15 intensive care units R-GNOSIS is evaluating the effectiveness of decolonisation using topical antibiotics to prevent infections with and transmission of MDR-GNB.

An additional ongoing study includes the contact isolation of patients with ESBL-producing Enterobacteriaceae in general hospital wards using alcohol hand rub dispensers.

Collectively, these studies will provide the material for studying fundamental biological aspects of the MDR-GNB-host interaction in the presence and absence of antibiotic selection pressure. Researchers are also investigating the mechanisms associated with the emergence and persistence of drug resistance, and are combining modelling approaches to predict plasmid transmissibility.

R-GNOSIS will offer necessary evidence for using antibiotics as a preventive strategy in intensive care patients as well as for patients after abdominal operations. The decolonisation-recolonisation data will also provide innovative approaches for dealing with persistent potentially life-threatening infections.