BARCOD

In-spite of continuous medical development globally, we are losing the race against antimicrobial resistant (AMR) bacterial pathogens. Pathogens adopt a variety of mechanisms to adapt to antibiotic onslaught. Biofilm formation is one such adaptive mechanism. Biofilms are communities of microorganisms protected by a self-generated matrix and adhere to either the surface of human tissue or to the surface of commonly used medical devices such as catheters and ventilators. The majority of recurrent or chronic human infections are a result of biofilm formation. Both detecting and treating such biofilm infections are difficult.

About BARCOD

It is estimated that biofilm-associated AMR alone costs US$94 billion in direct healthcare costs and 0.5M deaths per year globally. Currently followed empirical treatment of biofilms further increases AMR in hospitalised patients. In addition, this also increases the length and cost of hospital stay for patients. These pressing problems require evidence-based use of antimicrobials to not only contain AMR but also to achieve positive healthcare outcomes for patients.

The network, Biofilm and Antimicrobial Resistance Consortium of ODA receiving countries (BARCOD) led by the University of Sheffield, UK and Christian Medical College, India will ensure collection of baseline data on biofilm-AMR association in India. The study design can be easily mirrored to the status of other ODA countries. The network aims to impart knowledge on biofilm characterization from the University of Sheffield, UK and train the ODA participants to accurately identify and evaluate the prevalence of biofilm-mediated AMR in their countries. The workshops conducted as a part of the network will ensure knowledge sharing on existing research gaps in ODA countries and focus on developing collaborative solutions to address the issues of AMR and biofilm-mediated infections. Data from the network will be made accessible to relevant stakeholders – clinicians, pharmacists, government policy makers and the public.

Network aim

There is still a lacuna of data on association of antimicrobial resistance (AMR) and biofilm in India ^[1,2]. Although a few anecdotal cases have been reported , an overall prevalence of the biofilm forming organisms and their contribution to AMR burden in developing countries is not available ^[3]. As a background, in our clinical practice in India, infections in hospitalised patients have a major threat of developing biofilm infections due to longer duration of catheters and ventilators. Also, children with chronic adenoiditis are more prone to recurrent acute otitis media with effusion, in addition to recurrent infections in patients with orthopaedic implants and recurrent surgeries. The major pathogens isolated from these sites are K. pneumoniae, P. aeruginosa, A. baumannii and S. aureus ^[4].

With £0.7 million funding from Innovate UK, researchers in The University of Sheffield have established the Sheffield Collaboratorium for Antimicrobial Resistance And Biofilms (SCARAB). SCARAB is equipped with state-of-the-art research equipment to study biofilm formation at the interface between biofilms, human tissue and medical devices. SCARAB also incorporates academic expertise in biofilms, microbiology, tissue engineering, immunology, chemistry and computational modelling. Researchers in SCARAB routinely undertake projects in collaboration with industry and with clinicians. 

The University of Sheffield already has an existing successful collaboration with Christian Medical College, India, by obtaining a Global Challenge Research Fellowship via the University of Sheffield (2019). Through the BARCOD network, we will leverage the close working relationship between the University of Sheffield and Christian Medical College and the findings from the GCRF fellowship to initiate an India/UK collaborative consortium along with core partners from Sri Lanka, Thailand, Cambodia and Nepal in the healthcare aspects of biofilms. The primary objectives of BARCOD will be to increase our understanding of the prevalence and management of chronic biofilm and AMR-related infections in India and other ODA countries, and to develop a network of stakeholders well positioned to pursue and secure national and international funding to develop strategies for ensuring reduction of chronic biofilm-related infections in India. This will be achieved by building capacity in the biofilm and AMR research community and increasing the translation of biofilm research to solve healthcare problems.

Knowledge transfer between the relatively-interlinked research effort gained through this network should benefit all ODA countries by mirroring the data obtained from India. This will imply to all ODA countries and the structure of the network can be upscaled to fill the needs of all developing and developed countries.

The data will further act as an input for identifying the association of biofilm in AMR expansion and dissemination. This network will help to spread awareness of AMR-biofilm mediated infections in the hospitals to form strong Hospital Infection Control Committee (HICC) strategies.

The activities organised by the network will manage to deliver the following:

•    A roadmap outlining the prevalence and management of chronic biofilm and AMR-related infections in India.

•  A network of stakeholders well positioned to pursue and find solutions for existing knowledge gaps and influence healthcare policy makers for containing AMR in ODA countries.

•  Further, upscale the existing network including other ODA and developed countries, by obtaining larger grants to sustain and address public health problems related to AMR and biofilms

Goals of the programme

There is a growing awareness of AMR and biofilms primarily due to a conducive research atmosphere and governmental policies in the UK. However, AMR is still a global threat affecting the ODA receiving countries, particularly LMICs the greatest. Through collaborative research this project ensures that there is sufficient country-specific data to inform the development of an AMR policy and tailor the approaches for antimicrobial stewardship in ODA countries.

This project specifically addresses two UN SDG goals: 3) good health and wellbeing, and 10) reduce inequality within and among countries. A healthy workforce is pivotal to economic productivity. Through further funding, this research method established in this project can be extended to obtain country-specific AMR data in other ODA countries. In doing so, the UN SDG goals listed above will be met.

Specific anticipated benefits and impact:

• Understanding the burden of biofilm and AMR associations and their effect on the outcome of hospitalized patients
• Opportunity to share knowledge, exchange ideas with ODA countries with long-term sustainable relation
• Create awareness among relevant stakeholders and develop intervention strategies
• Improve patient management in terms of improved patient outcome with lesser treatment time, and reduced treatment cost by appropriate antimicrobial therapy for biofilm forming pathogens

Bibliography

1. Bulletin of the World Health Organization. 2016;94.

2. Center for Disease Dynamics, Economics & Policy. 2015. State of the World’s Antibiotics, 2015. CDDEP: Washington, D.C.

3. Percival SL, Suleman L, Vuotto C, Donelli G. Healthcare-associated infections, medical devices and biofilms: risk, tolerance and control. J Med Microbiol. 2015; 64.

4. Høiby N, Bjarnsholt T, Moser C, Bassi GL, Coenye T, Donelli G. ESCMID guideline for the diagnosis and treatment of biofilm infections 2014. Clin Microbiol Infect. 2015; 21.

Stakeholders 

National Biofilms Innovation Centre

Indian Medical Council of Research

Funders

The Academy of Medical Sciences

Global Challenge Research Fund