Journal of Clinical Microbiology, 52(5), 1 May 2014, pp 1741-44, doi: 10.1128/JCM.03614-13
Intensive Care Medicine, 40(4), 1 April 2014, pp 564–571, doi: 10.1007/s00134-014-3225-8
Expert Opinion on Therapeutic Targets, 18(8), 1 August 2014, pp 851-61, doi: 10.1517/14728222.2014.925881

Overall concept and objectives

The European community and health care settings are facing a dramatic increase in infections caused by MDR-GNB, with few effective therapeutic options remaining in the armamentarium of clinicians. There is a striking lack of new antimicrobial agents against MDR-GNB. Even if new agents were to be discovered, the lead in time is considerable as there are no truly new agents expected on the market in the short or medium term. Even if new agents were to come to market, on their own, they could not solve the resistance problem. Effective measures to contain resistance and limit the spread of MDR-GNB are therefore urgently needed to protect the health and well-being of the people of Europe and world-wide. We are confronted with a formidable enemy, equipped with sophisticated molecular methods to express and exchange resistance genes, capable of colonizing multiple reservoirs, and harbouring a bewildering array of virulence factors to infect any suitable host, both the hospitalised frail and healthy people living in the community.

The R-GNOSIS project aims at identifying the most effective measures for controlling selection and transmission of MDR-GNB and their genes, the most effective measures to reduce infections caused by MDR-GNB in relevant patient populations in the community and healthcare settings, optimizing treatment and prophylaxis strategies to avoid the detrimental consequences of these bacteria on patient outcome and investigating the critical molecular aspects for persistence and transfer of resistance genes in the human gut.

The scope of the problem (an estimated 25,000 people dying from infections caused by multiresistant bacteria in Europe in 2007, with infections caused by MDR-GNB increasing exponentially) means that ‘more of the same’ research is simply not an option. An “out-of-the-box” conceptual step-change is necessary, in which the evidence base is optimised for “well known but inadequately researched” infection prevention strategies through innovative and state-of-the-art study designs, and in which counterintuitive and highly innovative, solutions are identified and rigorously evaluated.

Transmission of MDR-GNB or their resistance genes