ComBac-Africa

The challenge

Sub-Saharan Africa faces the dual challenge of limited access to some antibiotics as well as some of the world’s highest levels of antibiotic resistance. Of particular importance are Gram-negative bacteria living in the gut, including Klebsiella pneumoniae and Acinetobacter baumannii, that are resistant to key classes of antibiotics (carbapenems and third-generation cephalosporins). These bacteria are an important cause of severe hospital-acquired infections. 

While efforts are needed to improve access to newer antibiotics that are active against such drug-resistant bacteria, introductions must be carefully managed to ensure their use only when clinically required, to avoid the overuse that would drive the development of antibiotic resistance. This depends on the capacity of health systems to identify the causes of infections and on their sensitivity to different antibiotics, so that patients can be prescribed the most appropriate drug.

In addition, infection prevention and control measures need to be optimised to prevent the spread of hospital-acquired infections and reduce the need for antibiotics in hospital settings. 

The project

The ComBac-Africa project is organising a range of activities to enhance access to a group of new antibiotics – cefiderocol, ceftazidime–avibactam, and aztreonam–avibactam – while also promoting stronger hospital infection prevention and control systems and antibiotic stewardship programmes.

Focusing on hospitals in Côte d’Ivoire, Guinea-Bissau, and Nigeria, the project is building institutional capacity in microbiological diagnostics by providing new equipment and training. It will work with clinicians in each hospital to strengthen infection prevention and control activities and antibiotic stewardship programmes. Newly developed clinical algorithms will help clinicians optimise the detection and management of serious infections. 

These activities will be informed by a programme of work to understand the local epidemiology of Gram-negative bacteria, which is generally not well characterised in sub-Saharan Africa. This will include whole-genome sequencing of clinical isolates, enabling the tracking of the transmission pathways of individual cases and suggesting where interventions should be targeted to reduce the risk of transmission.

To determine the impact of these activities, a clinical research study will run in parallel, comparing factors such as clinical outcomes and antibiotic usage before and after the intervention. 

Impact

The ComBac-Africa project could lead to significant improvements in the management of severe infections in hospitals across sub-Saharan Africa. It will:

• Help to establish healthcare practices that match patients to the appropriate treatment, improving clinical outcomes and avoiding overuse of antibiotics.
• Strengthen hospital capacities in key areas of infection prevention and control and antibiotic stewardship.
• Provide a mechanism to facilitate the introduction of multiple new antibiotics into sub-Saharan African healthcare systems.
• Explore a range of options to ensure sustainable access to these new antibiotics, including pooled procurement and technology transfer for local manufacture.

As well as enhancing the treatment of serious infections in the three participating countries, the ComBac-Africa project will generate important learning that will facilitate the wider, well-managed introduction of new antibiotics, increasing access to vital, life-saving treatments without misuse that would undermine their potency.