ASPIRE

The challenge

Antimicrobial resistance is a growing challenge globally, particularly in sub-Saharan Africa. An increasing number of infections no longer respond to standard antibiotic treatments, requiring the use of alternative antibiotics that may be more expensive or not readily available in sub-Saharan Africa. Drug-resistant infections are harder to treat, associated with worse outcomes for patients, and are more expensive for health systems to manage, due to longer hospital stays and the need for more expensive treatments.

Drug-resistant infections are a particular challenge in hospital settings, with some strains of bacteria, causing hospital-acquired infections, having become well-adapted to survive and spread in such environments. 

The rise of antimicrobial resistance is highlighting the importance of infection prevention and control. To do this, it is essential to reduce the need for antibiotics and to use them more precisely, with the right antibiotic at the right dose.

The project

The ASPIRE project is exploring a set of interventions, focusing on infection prevention and control and ‘antibiotic optimisation’ (tailoring of individual treatments), to improve clinical outcomes and rationalise antibiotic use at four hospitals in Ethiopia and Ghana.

• Infection prevention and control: The project will coordinate a baseline assessment of infection prevention and control policies and practices at each hospital, and explore the knowledge, attitudes and practices of hospital staff. These insights will be used to develop tailored interventions designed to improve infection prevention and control, focusing on hand hygiene (staff and hospital visitors) and surface cleaning.
• Antibiotic optimisation: The project will build the capacity of hospitals to both monitor bloodstream antibiotic levels in patients and to determine the antibiotic sensitivity of pathogens responsible for serious bacterial infections. Using this information, clinicians can adjust antibiotic dosing to ensure successful treatment outcomes.

The impact of these interventions will be assessed in a clinical trial. This will reveal:

• whether the interventions reduce pathogen detection in the hospital environment;
• whether clinical outcomes improve for patients receiving optimised treatments;
• and whether the new processes affect antibiotic use within hospitals. 

Measuring antibiotic levels in individual patients is a technically complex approach that could only be adopted in a limited number of well-resourced hospitals in sub-Saharan Africa. However, by collecting data on patients’ characteristics, treatments, and outcomes, the project aims to develop tools that hospital clinicians in the region could use to tailor treatment and optimise antibiotic use based on readily measurable patient and pathogen characteristics.

Impact

The ASPIRE project will have multiple short- and long-term impacts on patient care. It will: 

• Demonstrate whether an enhanced focus on infection prevention and control can reduce the number of hospital-acquired infections.
• Show whether antibiotic optimisation improves patient outcomes and leads to more rational use of antibiotics.
• Generate tools that would enable less well-resourced facilities to apply some of the learning acquired.

Ultimately, the project should improve treatment success at the hospitals in the study and suggest ways to protect the long-term potency of antibiotics through more appropriate use.