A Clinically-Oriented Antimicrobial Resistance Surveillance Network for Healthcare-associated infections (ACORN-HAI)

Funders:
Wellcome Trust.

Investigators:
OUCRU Nepal:

Associate Professor Abhilasha Karkey (Country PI)
Dr Sabina Dongol(Co-Investigator)
Narayan Kunwar(Project Manager)
Sushma Gyawali (Study Coordinator)

B.P Koirala Institute of Health Sciences

Dr. Basudha Khanal (Site PI)
Dr. Sanjib Kumar Sharma (Co-Investigator)
Dr. Narayan Raj Bhattarai (Co-Investigator)
Dr. Abilasha Sharma (Co-Investigator)
Dr. Shyam Prasad Kafle (Co-Investigator)
Dr. Krishna Pokharel
Dr. Robin Maskey

Bir Hospital, National Academy of Medical Sciences

Dr. Ashesh Dhungana (Site PI)
Dr. Ajit Rayamajhi (Site Co-PI)
Dr. Santosh Paudel (Site Co-PI)

A Clinically-Oriented Antimicrobial Resistance Surveillance Network (ACORN) is a multicentre study which aims to implement an efficient clinically-oriented AMR surveillance system, incorporated as part of routine workflow in low- and middle-income country settings (LMICs). A Clinically-Oriented Antimicrobial Resistance Surveillance Network for Healthcare-associated Infections (ACORN-HAI), which hinges on established ACORN platform, and focuses on severe HAIs. The prevalence of HAI has been estimated to be between 6% and 19% by the WHO in a 2016 report. Bloodstream infections (BSI) and Ventilator-associated pneumonia (VAP) were associated with the highest excess mortality of 24% and 29% respectively in Latin America, Asia and Africa adult patients. The overall aim of this study is to implement a large-scale multi-centre patient-centered surveillance network for AMR with a focus on severe HAI infections especially BSI and VAP, and also to form groundwork for subsequent interventional clinical trials targeting MDR infections including capacity building of microbiology laboratories, data collection and data sharing platforms. This study is a prospective cohort study of patients with HA-BSI or VAP. Patients receiving antibiotic treatment for BSI or VAP, with infections beginning more than 2 days after admission will be eligible for enrolment. The patient’s data will be collected on multiple exposures (infection episode) and outcomes (mortality) on paper CRF (Case report form) and later to REDCap database. Patients will be followed up for 28 days after the last HA-BSI or VAP infection episode. The outcome of this study will be applicable in knowing the incidence and prevalence of multidrug resistant organism in HA-BSI or VAP quantified in terms of hospitalisation, patient bed-days and microbiology cultures. And, also to identify HA-BSI or VAP by pathogen, antibiotic resistance phenotype. Furthermore, it can be useful for formulating the strategies to improve the infection prevention and control policies, guiding resource allocation, and motivating novel treatment therapy clinical trials.

Description of the study

ACORN-HAI is a large-scale multi-centre patient-centered surveillance network for antimicrobial resistance (AMR) with a focus on severe healthcare associated infections (HAIs). This study is a complementary study to the main ACORN protocol and hinges on the established ACORN platform with focus on severe healthcare associated infections (HAIs) especially blood stream infection (BSI) or ventilator associated pneumonia (VAP).

According to WHO,iIn Latin America, Asia, and Africa, bloodstream infections (BSI) and ventilator-associated pneumonia (VAP) were linked to the highest excess mortality rates, with 24% and 29% respectively among adult patients. To effectively design infection prevention and control policies, allocate resources, and support clinical trials for new therapies, it is essential to establish a robust surveillance system for HAIs caused by multidrug-resistant organisms (MDROs). This study provides a framework for conducting a large-scale, multicenter surveillance program focused on healthcare-associated BSI and VAP, with a particular focus on low- and middle-income countries (LMICs).

Primary objective:

To implement clinical antimicrobial resistance (AMR) surveillance of patients with healthcare associated-blood stream infections (HA-BSI) or ventilator associated pneumonia (VAP)

Secondary objectives:

To characterize treatment, clinical progression and outcome for healthcare associated-blood stream infections (HA-BSI) or ventilator associated pneumonia (VAP)
To quantify burden of mortality for healthcare associated-blood stream infections (HA-BSI) or ventilator associated pneumonia (VAP) caused by multidrug resistance organisms (MDROs)
To describe temporal trends in multidrug resistance organisms (MDROs) causing healthcare associated-blood stream infections (HA-BSI) or ventilator associated pneumonia (VAP)
To describe genomic epidemiology of multidrug resistance organisms (MDROs) causing healthcare associated-blood stream infections (HA-BSI) or ventilator associated pneumonia (VAP)

Target population:

Patients hospitalized with healthcare associated blood stream infections (HA-BSI) or ventilator associated infections (VAP) of any age (children and adults). The target sample size for Nepal is 500 participants (250 HA-BSI and 250 VAP).