Objectives

Aim

The overall aim of GRACE is to combat antimicrobial resistance through integrating and strengthening centres of excellence for studying the application of genomics with primary care practitioners, to community-acquired lower respiratory tract infections (LRTI), which is the leading reason for seeking medical care and consuming antibiotics.

GRACE will develop into a “European Lower Respiratory Tract Infection Research Centre” to investigate and improve the bed-site management of community-acquired LRTI.

 

Objectives

  • To study major community-acquired Lower Respiratory Tract Infections (LRTI), which are the leading reasons for antibiotic prescribing.
  • To study the role of “atypical” bacteria and viruses, including novel pathogens, in patients with community-acquired LRTI.
  • To develop novel rapid genome based diagnostic tests for the detection of pathogens implicated in community-acquired LRTI.
  • To establish a European repository of specimens and strains linked to a database including microbial and patient information.
  • To assess risk factors for infection with resistant S. pneumoniae and H. influenzae in patients with community-acquired LRTI.
  • To determine the relationship between the exposure to antibiotics at the individual and population level and resistance.
  • To correlate antibiotic resistance, virulence characteristics and pneumococcal genotype to severity of community-acquired LRTI aiming to optimise future treatment and prevention strategies.
  • To perform comparative pneumococcal genomics with micro-array technology with the aim of finding genes important for virulence and for antibiotic resistance development.
  • To undertake a large scale genome wide screen for human susceptibility genes affecting severe community-acquired LRTI and thereby identify potential target pathways for new immunomodulatory approaches.
  • To use human genomic data to devise the potential genetic risk profile for community-acquired LRTI and assess whether these polymorphisms identify individuals at risk of various presentations and outcomes of community-acquired LRTI in several European populations.
  • To determine whether the human genetic risk factors identified in GRACE interact with each other or with key microbial genetic or other environmental risk factor for community-acquired LRTI.
  • To describe current community-acquired LRTI management and analyse the determinants of antibiotic use in 10 to 15 primary care networks across the EU, using qualitative and quantitative approaches.
  • To develop internationally agreed evidence-based definitions of the major community-acquired LRTI.
  • To identify and develop appropriate clinical outcome measures for evaluating interventions.
  • To develop clinical models to differentiate viral from bacterial infections and identify pneumonia.
  • To develop clinical models to identify patients at risk for adverse outcomes including severe and prolonged illness.
  • In a placebo controlled trial, to assess the effectiveness of antibiotics among patients with community-acquired LRTI in order to fill the current gap in evidence about which subgroups selectively benefit from antibiotic treatment, and which subgroups do not benefit.
  • To develop and assess a practice based intervention using the novel data generated from the network in reducing inappropriate antibiotic use in patients with community-acquired LRTI and explore the effect on antibiotic resistance.
  • To model the cost-effectiveness of the management strategies developed in the observational studies.
  • To conduct economic evaluations in parallel with the intervention studies.
  • To model the macroeconomic impact of antibiotic resistance and policies to contain resistance.
  • To conduct economic evaluations of molecular diagnostics.
  • To contribute information aimed at increasing awareness among the public and policy makers of the importance, economic impact and threat of antimicrobial resistance.
  • To develop education and training support to disseminate awareness and knowledge relevant to antibiotic resistance and its control.
  • To develop educational packages including web-based resources and workshops to inform postgraduate lifelong learning needs of prescribing professionals.