Emerging Microbial threats

he Global Point Prevalence Survey of Antimicrobial Consumption and Resistance (Global-PPS) project aims to provide a tool to measure and monitor antimicrobial prescribing and resistance in inpatient and outpatient settings worldwide. The methodology of point prevalence surveys is used to provide quantifiable measures to assess and compare quantity and quality of antimicrobial prescribing and resistance in in- and outpatient adults, children and neonates worldwide. As such, Global-PPS supports healthcare institutions to identify targets for improvement of antimicrobial prescribing, to design contextualized antimicrobial stewardship interventions, and to measure the impact of these interventions in the context of quality improvement.

Effective response to AMR entails prudent antimicrobial use (AMU) and improvement of AMU surveillance, which are both key priorities of the EU One Health Action Plan on AMR, suggesting antimicrobial stewardship programmes (ASP) need to be strengthened across the Union. ASP as recognised step towards improving AMU, has 3 core components: a) system prerequisites (BASICs, including AMU measurement); b) WHAT the AMS team wants to improve; and c) HOW the AMS team will achieve these goals. In existing programmes, a lot of emphasis is placed on the 'WHAT' of AMS, and little attention is generally paid on the 'HOW' within an ASP: HOW to make sure professionals comply to these 'WHAT' recommendations. This usually requires behaviour change approach. General objective of DRIVE-AMS is to reduce inappropriate AMU through supporting effective implementation of Antimicrobial Stewardship (AMS) interventions using a step-wise behaviour change approach. This objective will contribute to the European and national targets for reducing inappropriate antimicrobial use and tackling AMR. Combining the 3 key elements (measurement, training and implementation) into one DRIVE-AMS course would enhance the impact of data-driven training and sustainable AMS implementation, through: i) understanding AMS principles (BASICS, the WHAT); ii) identifying gaps in AMU by pre-course Point Prevalence Survey (PPS); iii) providing 4-day course on the HOW of AMS, and developing "My Project" AMS intervention; iv) providing 6-month expert support for "My Project" implementation; v) measuring impact by post-course PPS. DRIVE-AMS project will: a)build capacity of national experts; b)deliver national DRIVE-AMS courses; c)provide expertsupport for "My Project" implementation. To enable accessto DRIVE-AMS in rest of Europe, we foresee: a) continuation of national DRIVE-AMS courses, extending capacity (TTT) to other EU countries, continuing G-PPS support, sustaining expert support to EU and non-EU countries.

Pandemic preparedness includes many challenges and activities. Healthcare workers in primary care (such as family physicians, emergency room and ambulance workers) play a special role in this. They are the first ones to be confronted with a new threat; missed diagnoses can quickly trigger local outbreaks and further spread, including within the healthcare facility. Effective surveillance therefore requires well-trained staff in the field, who can recognize unusual or high-risk situations, sound the alarm and initiate a proper response. The European Centre for Disease Prevention and Control (ECDC) already recommended our country in 2015 to strengthen the preparedness of first-line healthcare providers.

The sudden emergence of COVID-19 in 2020 and of Mpox in Europe in 2022 has demonstrated the variability of how a new threat can emerge. Preparing as generically as possible for a "worst case scenario" is essential; WHO therefore launched the concept of "preparedness for virus X" (2018). The challenge here is to keeping knowledge readily available about rare, impactful pathology, within professionals whose day-to-day expertise lies elsewhere. Viral hemorrhagic fever (VHF) could be used as a proxy for this given its high mortality, high risk for nosocomial infection and permanent risk. VHF often presents itself with small-scale outbreaks, but such high-impact pathogens can spread rapidly if they enter settings that are insufficiently prepared for them.

Since 2016, we have procedures and training for VHF in Flanders/Belgium, but these mainly focus on the last part of the response chain. In this project, we want to develop a method and training package that can be used to systematically train first-line healthcare workers at the beginning of the alert and response chain, where alertness, recognition of infectious risk situations and a correct response can be tested and practiced. The package and method will be compiled in consultation with the relevant professional groups and authorities, and will also be tested internationally. To our knowledge, such a didactic program does not yet exist in Belgium, and by extension in Europe, and is therefore a first in its kind. It is therefore the intention within the project to further develop this "ugly" prototype (TRL4) to a TRL6 level (prototype system tested in intended environment close to expected performance).
The primary partnership of this project consists of the UAntwerpen (UA), the University Hospital of Antwerpen (UZA) and the Institute of Tropical Medicine (ITG), with Radboudumc as international partner. The three Antwerp institutions already have decades of sustained collaboration in the care of patients with infectious diseases, and in research and training on infectious diseases; they already collaborated intensively in VHF-preparedness and COVID-19 response. Recently, this collaboration was extended to Radboudumc.

 
The project includes four work packages: (1) General coordination and project management; (2) Compilation of didactic package and writing of different exercise scenarios; (3) Organization of a summer course focused on pandemic preparedness within the health system and (4) Performance and analysis of pilot exercises with international validation.
During the work, field partners from different disciplines (professional organizations, health authorities, educational experts) will be invited to monitor the content, methodology and improvement cycle within the process.
The ultimate goal is that this training package would not only be rolled out within Flanders/Belgium, but could also be further tested and used at the European level to keep front-line workers trained.This partnership will therefore already establish contacts with other European HLIUs during this project in order to further Europeanize this roadmap in a second stage.

IDEALiTER is the continuation of the European projects IDEAL and IDEAL+, financed by Erasmus +, for a period of three years (2022-2025). Partnering institutions include: Università Cattolica del Sacre Cuore (Rome), Ethniko Kai Kapodistriako Panepistimio Athinon (University of Athens), Universiteit Antwerpen (Antwerp), UMC (Utrech Medisch Centrum), Hamburg Eppendorf Universitätsklinikum (Hamburg) and Université Paris Cité as well as the associated partners – NHS Lothian (Edinburgh) and Aston University (Birmingham) and the members of the external committee (UniCamillus of Rome and University of Leeds).
IDEALiTER is dedicated to students and teachers and intends to deepen the contents of the training courses initiated by IDEAL and IDEAL+. IDEALiTER is therefore a program that improves the initial courses and allows students to deepen their knowledge of infectious diseases, innovative teaching methods and to consolidate a network of health professionals throughout the European Union. Its activities include a yearly 'train the trainer'-course, the organisation of 2 yearly seminars dedicated to a hot topic in infectious diseases in each partner institution, and the yearly organisation of a Summer School.
The participating medical students will be able to participate to advanced courses on infectious diseases taught by professors from the European partner universities and summer schools and to access free online resources. Young teachers will be able to learn new and innovative teaching methods, such as "Teach the trainers". This innovative teaching method allows students to be accompanied on several case studies based on symptoms given during the course and allowing diagnosis. Mentoring for other universities in the European Union will also be set up so that they can develop the "IDEAL method" within their program.

Antimicrobial Resistance, Prescribing, and Consumption Data to Inform Country Antibiotic Guidance and Local Action

To overall aim of this project is to optimise antimicrobial use and improve patients' outcomes by enhancing antimicrobial stewardship (AMS) programs in the outpatient setting in Africa. The specific objectives of this project are: (1) To develop a comprehensive standardized surveillance protocol to collect, monitor and evaluate antimicrobial use patterns in the outpatient setting; (2) to design meaningful and contextualized stewardship activities that aim at increasing appropriate prescribing and at cutting down over-the-counter use both from the perspective of the provider (healthcare professional or other) as well as from the person (patient) demanding antibiotics in the outpatient setting; (3) to educate and train healthcare workers on the principles of AMS.  The study will be conducted in a set of outpatient clinics in the hospitals, outpatient clinics in primary health care centres and registered community pharmacies and retail drug outlets/vendors in Nigeria, Burkina Faso and Togo.