Aclinicaly oriented Microbial resistance surveillance network
Abstract
EXECUTIVE SUMMARY
Type of study: Descriptive prospective surveillance
Problem to be studied: Antimicrobial resistance (AMR) is a major threat to human health with
estimates of 10 million AMR deaths per year by 2050. However, these estimates are based on
limited data, largely from high-income settings. There is an urgent need to generate better data
on the clinical impact on AMR, especially from resource-limited settings. Currently many AMS
surveillance systems are passive, pathogen focused, using information from medical laboratories
only. As such, we are missing critical information such as impact and cost of drug resistant
infection (DRI) at the patient level and patient-level risk factors. This information is crucial in
making local and global decisions about treatment and policies.
The ACORN2 project is implementation of a clinically orientated antimicrobial resistance
surveillance programme of hospitalized patients with suspected acute bacterial infections across
15 sites in 9 countries, of which QECH will be the only site in Malawi.
Objectives
Primary objective: Implement clinical antimicrobial resistance (AMR) surveillance of
hospitalised patients between 0 to 17 years with suspected acute bacterial infections
Secondary Objectives
To characterise drug-resistant infections (DRI) by clinical syndrome, place of
acquisition (CAI, HAI, HCAI), patient group (adult, paediatric, and neonatal), and
location (site, country, region)
To determine the attributable mortality for extended spectrum beta-lactamase
producing Escherichia coli, methicillin resistant Staphylococcus aureus bloodstream
infection and Enterococci.
To determine the major indications for prescribing parenteral antibiotics by patient
group (adult, paediatric, neonatal), timing of prescription (day of admission versus >2
days after admission), and location (site, country, region)
To determine the major empiric antibiotics used by clinical syndrome, place of
acquisition (CAI, HAI, HCAI), patient group (adult, paediatric, and neonatal), and
location (site, country, region)
To explore clinician knowledge, attitudes, and practice towards AMR surveillance
Methodology
Setting: Queen Elizabeth Central Hospital
Population to be studied: Hospitalised patients aged 0t0 to 17 years at QECH, Blantyre with
suspected or confirmed bacterial infection with a focus on paediatric in-patients.
06-Jun-2022
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ACORN2,Version 12.0, 9 November 20215th May 2022
Number of Participants: 2500 patients for the surveillance data and 30 clinicians for KAP
survey.
Duration: 24 months of recruitment with follow up at 28 days post enrollment. There will be 6
month follow up for a subgroup of patients with gram positive invasive infection
(Staphylococcus Aureus, Escherichia coli and Enterococci)).
Expected Findings and Dissemination As forin ACORN1, 88% and 75% of enrolled patients
had a blood culture taken for Cambodia and Laos respectively. Of those, approximately 5% of
blood cultures will yieldyielded a target organism (pilot: 4.9% for Cambodia and 7.4% for Laos),
therefore it is expected that the surveillance across all ACORN 2 sites will yield 37,500 patient
episodes, 30,000 blood culture results, and 1,500 target pathogen blood culture isolates with AST
data (1).
The
In Malawi, the study findings will be shared weekly with the paediatric department as part of an
existing dashboard, and with the Antimicrobial Resistance Committee at Queen Elizabeth
Central Hospital to which the chairperson for the committee has agreed. A final report including
any published papers will be submitted to the 7CollegeCollege of Medicine Research Ethics
CommitteeSecretariat ,Committee Secretariat, the Kamuzu University of Health Sciences
Library and other international conferences.