RESET Program: Determining Prevalence of ESBL-producing Enterobacteriaceae

This solution addresses untracked strains of drug-resistant enterobacteriaceae in Germany for humans (hospitalized patients, outpatients, healthy persons), animals (livestock and pets), animal food and environment (wastewater, shed environment)

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Problem Description

This solution was created: 1. To determine the prevalence of ESBL-producing bacteria in humans (hospital, ambulant, community), animals (livestock, pets), animal food and the environment (wastewater). 2. To identify the respective resistance genes and analize their transferability between enterobacteriaceae. 3. To compare genetic relationship of bacterial isolates and resistance gene carrying plasmids in different settings (human, animal, environment) to evaluate the transmission pathways of ESBL-resistance.

Building Blocks

Story

This project was initially funded in 2010 to help researchers in Germany study recent resistance evolution in Enterobacteriaceae. It is one part of Germany's larger German Antimicrobial Resistance Strategy
(DART2020). The project brings together 10 different research entities that study all the important sources of bacterial evolution. It will continue to be funded until 2016. It's research has yielded important knowledge on possible transmission routes between animals, food and humans as well as potential reservoirs of drug-resistant bacteria. The program has been recommended by the G7 as a best-practice for Combating Antimicrobial Resistance.

Sustainable Development Goals

On September 25th 2015, countries adopted a set of goals to end poverty, protect the planet, and ensure prosperity for all as part of a new sustainable development agenda. Each goal has specific targets to be achieved over the next 15 years. This solution covers the following goals:

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Social Progress Index

  • Nutrition and Basic Medical Care - Do people have enough food to eat and are they receiving basic medical care?
  • Access to Information and Communications - Can people freely access ideas and information from anywhere in the world?
  • Photos

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    Resources

    • Combating Antimicrobial Resistance Examples of Best-Practices of the G7 Countries

      RESET documented on pp. 15, under the "One-Health Approach"

    • Guidelines on Good Clinical Laboratory Practice

      Abstract: "A set of Good Clinical Laboratory Practice (GCLP) standards that embraces both the research and clinical aspects of GLP were developed utilizing a variety of collected regulatory and guidance material. We describe eleven core elements that constitute the GCLP standards with the objective of filling a gap for laboratory guidance, based on IND sponsor requirements, for conducting laboratory testing using specimens from human clinical trials. These GCLP standards provide guidance on implementing GLP requirements that are critical for laboratory operations, such as performance of protocol-mandated safety assays, peripheral blood mononuclear cell processing and immunological or endpoint assays from biological interventions on IND-registered clinical trials. The expectation is that compliance with the GCLP standards, monitored annually by external audits, will allow research and development laboratories to maintain data integrity and to provide immunogenicity, safety, and product efficacy data that is repeatable, reliable, auditable and that can be easily reconstructed in a research setting."

    • Extended spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae: considerations for diagnosis, prevention and drug treatment.

      Abstract: "Extended spectrum beta-lactamase (ESBL)-producing organisms pose unique challenges to clinical microbiologists, clinicians, infection control professionals and antibacterial-discovery scientists. ESBLs are enzymes capable of hydrolysing penicillins, broad-spectrum cephalosporins and monobactams, and are generally derived from TEM and SHV-type enzymes. ESBLs are often located on plasmids that are transferable from strain to strain and between bacterial species. Although the prevalence of ESBLs is not known, it is clearly increasing, and in many parts of the world 10-40% of strains of Escherichia coli and Klebsiella pneumoniae express ESBLs. ESBL-producing Enterobacteriaceae have been responsible for numerous outbreaks of infection throughout the world and pose challenging infection control issues. Clinical outcomes data indicate that ESBLs are clinically significant and, when detected, indicate the need for the use of appropriate antibacterial agents. Unfortunately, the laboratory detection of ESBLs can be complex and, at times, misleading. Antibacterial choice is often complicated by multi-resistance. Many ESBL-producing organisms also express AmpC beta-lactamases and may be co-transferred with plasmids mediating aminoglycoside resistance. In addition, there is an increasing association between ESBL production and fluoroquinolone resistance. Although in in vitro tests ESBLs are inhibited by beta-lactamase inhibitors such as clavulanic acid, the activity of beta-lactam/beta-lactamase inhibitor combination agents is influenced by the bacterial inoculum, dose administration regimen and specific type of ESBL present. Currently, carbapenems are regarded as the drugs of choice for treatment of infections caused by ESBL-producing organisms. Unfortunately, use of carbapenems has been associated with the emergence of carbapenem-resistant bacterial species such as Stenotrophomonas sp. or Pseudomonas sp."

    Organisations Involved

    Solution Stage

    One of the 7 stages of an innovation. Learn more
    STAGE SPECIALIST SKILLS REQUIRED EXAMPLE ACTIVITIES RISK LEVEL AND HANDLING FINANCE REQUIRED KINDS OF EVIDENCE GENERATED GOAL
    Developing and testing3
    Mix of design and implementation skills
    • Rapid prototyping
    • Service, product and process design
    • Co-design
    • User-design
    • Light-touch evaluation
    • Cost-benefit modelling
    • Randomised control trials
    • High failure rate should be an explicit expectation
    • Visible senior leadership essential
    HIGH
    • Grants, convertible grants/loans
    MEDIUM
    A stronger case with cost and benefit projections developed through practical trials and experiments, involving potential users
    Demonstration that the idea works, or evidence to support a reworking of the idea

    Key Details

    Social Progress Index
    Nutrition and Basic Medical CareAccess to Information and Communications
    Sustainable Development Goals
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    Activity