- Project Organization
- Project Structure.
- Peripheral or Local Level:
- Central Level:
- Scientific objectives of the Project
- Local or peripheral level
- A local guide for the empirical use of antibiotics based on local ecology which is an intervention by itself.
- Impact assessment of control measures that are implemented.
- Assessment of other causal factors of resistance: hospital hygiene measures, control measures for the colonization pressure, etc..
- Central level
- The comparison among participants in terms of levels of resistance and antibiotic use and therefore the ability to detect problems at the local level.
- The exploration of new methodological techniques that enable progress in understanding the problem of resistance:
- Multi-equation methods: Development of multicenter studies of relationship between resistance and antibiotic use (and other factors, hospital hygiene, …) in searching of common patterns of behaviour thus raising the scientific evidence and improving the understanding of the mechanisms of resistance.
- Nonlinear methods:
- These types of models try to set the levels of antibiotics use that promote or trigger resistance once reaching a certain threshold. In a depressing scenario of the lack of research of new antibiotics, it is necessary to optimize the use of what is available, and therefore it is necessary to know, in a rigorous way, the limits of use of the available antibiotics that show an uncertain effectiveness because of the dynamism of bacterial ecology.
- This methodological approach also allows us to detect nonlinear relationships in time due to different intensities of the impact of changing or absent factors at any given time, which will enhance our knowledge of the dynamics of the resistance
- Vectorial methods: to detect bidirectional relationships.
- The econometric support at the central level will strengthen the approach between two areas of knowledge, medical and econometrical, filling the current existing gap that forces many researchers to look for methodological support often in an erratic manner and without guaranty of continuity.
- The overall data availability of levels of resistance and antibiotic use will allow public health managers to develop policies and strategies for the addressing of a problem that has reached very worrying levels and for whose control it is necessary a rigorous level of information.
The phenomena of resistance in relation to the use of antibiotics should be studied at the local level since this is where the ecological mechanisms act, that influence the bacterial flora changes that will manifest as resistance.
Currently there is no European network that studies the phenomena of resistance and the antibiotic use at the local level together to allow pooling of advances in the knowledge of these matters.
In recent years, the use of Time Series Analysis techniques in the study of resistance and its connection with the use of antibiotics have been adopted as a very common methodology and accepted by the scientific community. It is important now, to facilitate their use in a systematic way.
The study of resistance and antibiotic use by means of Time Series Analysis techniques mostly implies an stage of extraction and processing of data that is time consuming and it must be repeated next time you want to perform another study.
On the other hand, econometric techniques of Time Series Analysis are indeed complex and difficult to manage for professionals who do not come from the economics area. Added to this is the fact that superficial knowledge on the part of researchers who come from the medical field prevents us from applying some of the more advanced techniques that could benefit us in our goal of further studying of the understanding of the problem of resistance.
Finally, being compared with other hospitals can provide guidance on the way to go in our own environment. Therefore the interest in creating a network.
The project is organized around a non-profit association, “Asociación ViResiST para el Estudio dela ResistenciaAntimicrobiana”, that manages the relationships between centres, financial issues and ensures compliance with the rules of procedure.
The Association is made up of researchers and it will have a Scientific Council that will point out the preferred lines of research.
A technical company will be responsible for providing all human and material resources at both the peripheral and central level (full-time service of a professional in econometrics, central computer system, website, computing support to the participating centres, etc.). Among other issues, it will install a system in each hospital so that original data will not go out of it and that only time series will be exported to the Central Server where access will be subjected to a series of rules to protect the rights of their original owners. Clearly this will have a cost that must be assumed by the beneficiary hospitals. For this reason it will be set a contribution (quite modest) to be paid to the Association that will be responsible for payment for services of the company.
The Association will devote its surplus, when available, to a line of scholarships and research grants within the project.
It is expected to try to fund the provision of hospitals that adhere in the future by means of EU or other public funding.
The project is structured in two levels: Peripheral or Local Level and Central Level.
Here it can solve technical issues of collection, export,data processing and presentation for its scientific exploitation. It is about creating databases of time series for resistance and antibiotic use that will be updated automatically and easily retrievable via web. This is a technical issue that should not pose significant technological challenges but we have to dedicate resources to this task: scheduling automated extraction, defining dictionaries of uniform codes for everyone, creating programs so that local data will be automatically transformed into common language, calculation of time series and, finally, the creation of a graphical interface for consultation of results and selection and download of series which are the subject for specific studies.
Here it is about centralizing and facilitating scientific exploitation of the information which in itself, will benefit from the fact that whatever you want can be studied easily by pressing two keys of the keyboard and also, and this is very important, easily exploring all phenomena of resistance and antibiotic use in a given hospital (or elsewhere) which may suggest many hypotheses to be verified later. Added to this is the interesting possibility to compare our situation with other places.
The project aims to examine two aspects of the fight against bacterial resistance:
The system will provide the information needed to develop a policy for antibiotic use on a scientific base:
The system will create a large multicenter database of resistance and use of antibiotics and provide the essential methodological support in the field of econometrics which will allow: