Grant: Operating Grant: Joint Programming Initiative on Antimicrobial Resistance

Antimicrobial resistance and infections associated with healthcare have become a major threat worldwide. Overuse and misuse of antibiotics significantly contribute to this problem - but the extent to which governance of antibiotics and measures to limit spread of bacteria within the healthcare setting can help curb the epidemic of drug-resistant bacteria, is not known.We hypothesize that healthcare exposure and inappropriate antibiotic prescriptions are critical steps in the pathway from acquisition of drug-resistant organisms to changes of patients' gut flora, eventually leading to infections with drug-resistant bacteria. This study will be conducted in 6 countries and will focus on patients at high risk of developing an infection during the course of their medical care. We will assess the quality of the antibiotic prescriptions through an international board of infectious diseases experts, will perform behavioral analysis (through interviews and self-assessment questionnaires) of selected prescribing physicians in order to better understand the reasons behind inappropriate antibiotic prescriptions in different countries, and also perform in-depth laboratory analysis of patient specimens before and after antibiotic therapy, to characterize the biological events leading to alterations in the gut flora and eventually, infection. Our findings will help determine the effectiveness of specific interventions and will guide the optimal management of patients newly entering the healthcare environment and at risk of developing drug-resistant infections.