Antimicrobial resistance & treatment of infections

AMR

The main part of this research focusses on the evolving epidemiology of antimicrobial resistance AMR in clinically relevant micro-organisms, on understanding the impact on health and disease of this ongoing process, and in particular on the consequences of increasing AMR for (new) antimicrobial strategies, antibiotic policy making  and antibiotic stewardship. The ongoing selection of resistant micro-organisms worldwide is caused by the use of antimicrobial agents and xenobiotica and has an increasing impact on the available treatment options for patients with bacterial and fungal infections. However, to what extent and at which pace AMR will affect the outcome of patients with infections caused by clinically relevant micro-organisms, remains to be studied for many common infectious diseases. Due to AMR, adaptations in empiric treatment strategies and new diagnostic approaches will be required.

The research is centred around research questions that develop directly from patient-care and dilemma’s in antimicrobial policy making. Hereby, using epidemiology as a science to study the above named research questions.

Previous research concerned several studies on antimicrobial stewardship and electing optimal empiric antimicrobial therapy in patient cohorts with bacteremia. The results showed the clinical relevance of the time to positivity of blood cultures and untangled determinants of physician attitudes and behaviour with regard to selecting empiric broad spectrum antimicrobial

therapy. The impact of increasing antimicrobial resistance rates herein played a central role. In addition research on the consequences of a mismatch of the susceptibility pattern of  bacterial pathogen with empiric antimicrobial therapy in patients with positive blood cultures was conducted.

In an ongoing project focussed on antimicrobial treatment strategies for biofilm associated infections, in particular prosthetic joint infection (https://www.protheseinfectie.nl/)

the effects of different treatment strategies are assessed in a large prospective cohort. Recently, a ZonMW grant was obtained to perform a randomized controlled trial comparing two different antimicrobial regimes.  In our lab a mature biofilm model was developed by our group to also study new antibacterial treatment options such as antimicrobial peptides and bacteriophages, for multidrug resistant bacteria, in vitro.

In addition, the model is used for improving our understanding of so-called ‘persister’, i.e. dormant bacteria that survive antimicrobial therapy while protected in biofilm.

With regard to antibiotic stewardship and e.g. studies about treatment of sepsis/bacteremia current collaborations are with the Amsterdam University Medical Center, and are being set up with Duke University (US) on the topic of treatment strategies for S. aureus bacteremia. In the PERISCOPE project, in which we use artificial intelligence to predict infection and or resistance with big data, there is collaboration with Nijmegen UMC, the Department of Intensive Care Medicine (LUMC) and a start-up company.

There is an ongoing collaboration with department of public health and primary care (PHEG & campus Den Haag) to address a set of of the public health aspects of AMR as well as antimicrobial strategies in primary care (e.g. on resistance development,  antibiotic stewardship and on the epidemiology of antibiotic resistance development in Helicobacter pylori).