Research Erika Vlieghe

Abstract

Our gut microbiome is affected by many factors, and it seems (prescribed) drug use is one of the most important factors affecting its' composition and function. The first years of life are crucial for the acquisition of a healthy and stable gut microbiome, yet infancy is also when we use most antibiotics. Young infants may also receive gastric acid inhibitors for gastro-oesophageal reflux symptoms although efficacy and safety have been questioned. As antibiotics and gastric acid inhibitors are known to disrupt the gut microbiome in adults, these could even have larger and long-lasting effects on the microbiome and health of young children. With these projects, we want to contribute to mapping antibiotics and protonpump utilisation during early childhood – to assess the potential extent of overconsumption. We also want to explore drug-microbiome interactions in young children, and the potential bi-directional effect on infections. These projects might have direct clinical implications, by contributing to improved prescription practices and reducing inappropriate intake.

Researcher(s)

• Promoter: Brusselaers Nele
• Co-promoter: Vlieghe Erika
• Fellow: Orwa Sheila

Research team(s)

• Global Health Institute (GHI)

Project type(s)

• Research Project

Abstract

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.

Researcher(s)

• Promoter: Vlieghe Erika

Research team(s)

• Global Health Institute (GHI)

Project website

Project type(s)

• Research Project

Abstract

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.

Researcher(s)

• Promoter: Vlieghe Erika

Research team(s)

• Global Health Institute (GHI)

Project website

Project type(s)

• Research Project

Abstract

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.

Researcher(s)

• Promoter: Vlieghe Erika

Research team(s)

• Global Health Institute (GHI)

Project website

Project type(s)

• Education Project
• Research Project

Abstract

In 2015, the World Assembly endorsed the Global Action Plan (GAP) on antimicrobial resistance (AMR) encouraging countries to develop of National Action Plans (NAP) to tackle AMR. As of 2022, 148 countries had a NAP with an additional 38 countries in the process of developing their NAP. While improvements in collection of microbiology and antibiotic consumption data have been helpful to inform countries of the scale of the issue, guidance on how best to use these data at a country level to inform prescribing practices and improve clinical outcomes based on local priorities is urgently needed. The goal of the 'Antimicrobial resistance, prescribing, and consumption Data to Inform country antibiotic guidance and Local Action' (ADILA) project, funded by the Wellcome Trust, is to optimise the use of AMR surveillance data by developing tools that can be implemented nationally to inform and support individual country's policies on improving the quality of antibiotic use. The proposal aims to learn from the development of clinical surveillance in other disease areas and provide a conceptual framework for future implementation. This project combines expertise on antimicrobial resistance, usage modelling, and policy development. It aims to model existing datasets to provide a framework for future clinical patient-centred AMR surveillance, that can inform empiric prescribing guidance and support local policy decisions. The proposal has been developed to link closely with current and planned WHO AMR initiatives, including the AWaRe handbook, and the work of other key stakeholders.

Researcher(s)

• Promoter: Vlieghe Erika

Research team(s)

• Global Health Institute (GHI)

Project website

Project type(s)

• Research Project