Antimicrobial resistance

We welcome proposals for clinical and applied health research into the evaluation of public health measures, health care interventions and health services to reduce the development and spread of antimicrobial resistance (AMR) and consequent morbidity.

NIHR operates a number of research funding schemes and this highlight notice is to indicate NIHR’s continuing interest in receiving research proposals in the area of AMR at any time in order to improve patient and public outcomes and NHS services.

There is currently a funding opportunity from a Department of Health partnership with the Medical Research Council (MRC).

Participating programmes - apply now

Research proposals must be within the remit of one of the following participating NIHR programmes (see table below). Applications can be made at any time, as part of each programme's standard researcher-led workstream. 

Please note that submission dates vary and completed forms must be submitted by the date specified on the relevant programmes’ website as linked below. 

 

ProgrammeApply Now
Efficacy and Mechanism Evaluation (EME) Programme Researcher led workstream
Health Services and Delivery Research (HS&DR) Researcher led workstream
Health Technology Assessment (HTA) Programme Researcher led workstream
Invention for Innovation (i4i) Programme Researcher led workstream
Programme Grants for Applied Research (PGfAR) Programme Researcher led workstream 
Public Health Research Programme (PHR) Programme Researcher led workstream
Research for Patient Benefit (RfPB) Programme Researcher led workstream

 

In recognition of the methodological complexities associated with research in this area applications which propose novel study designs, such as adaptive trial design, would be particularly welcome. Given the need for research supported by NIHR to demonstrate impact on patient and public health outcomes, the causal pathway and justification of the short and longer term outcome measures should be clearly stated in all cases.

Background

In July 2013 the NIHR issued a call for research into the evaluation of public health measures, health care interventions and health services to reduce the development and spread of antimicrobial resistance (AMR) and consequent morbidity.

This call for research was part of a coordinated response by the NIHR to the publication of the 2nd volume of the 2011 Annual Report of the Chief Medical Officer: Infections and the rise of antimicrobial resistance. It also supports the Department of Health-led UK Antimicrobial Resistance Strategy which sets out how the challenges outlined in the report will be met.

This call intended to cover all aspects of translational, clinical and public health research that could through new developments or changes in practice contribute to a reduction in the development and spread in humans of organisms with antimicrobial resistance, and infection.

As part of the NIHR’s activities in this area, the NIHR AMR Reference Group was established to provide direction and guidance on important areas for future research which would be achievable within a reasonable timeframe and have maximum impact on patient and public outcomes.

The NIHR AMR Reference Group identified the following key priorities to guide future research and the NIHR would particularly welcome applications on, although not limited to, research in these areas.

 

Research Themes

Theme 1: Reducing the Need for Antibiotic Use - Improving infection prevention and control practices in both healthcare and community settings

High standards of infection prevention and control will remain crucial to minimise the risk of infection and limit the emergence and spread of multi-drug resistant organisms in human and animals. This need for further evidence relating to prevention and control applies to all healthcare settings such as hospitals as well as community settings and long term care facilities.

For example, improvement in hand hygiene in both healthcare and non-healthcare settings can significantly reduce infections and subsequently the need for antibiotics. However, uncertainty remains about what are the most effective and cost-effective interventions to support sustained behaviour change and reduce transmission of resistant organisms.

Research questions identified within this theme include: 

  • Can we identify patients at high risk who might develop healthcare associated infections (HCAI) e.g. can innovative surveillance tools using hospital data identify those individuals at highest risk, or recognise the importance of recent travel
  • Alternatives to using antibiotics in the primary care setting to contribute to a reduction in antibiotic prescribing?
  • What are the most cost-effective ways to manage people with resistant strains of infection and prevent further spread? What are the needs of the workforce to deal with these challenges?

  

Theme 2: Supporting and Promoting the Responsible Use of Antibiotics - Optimising prescribing practice in primary and secondary care

Inappropriate use of antibiotics is a key driver in the spread of antibiotic resistance. There is already an extensive range of guidance, education, tools and industry-sponsored initiatives to promote the responsible use of antibiotics in patients and animals, but most prescribing is carried out with limited information about the nature of the infection or before the results of diagnostic testing are available (UK Five Year Antimicrobial Resistance Strategy 2013 to 2018, Department of Health, September 2013)

A recent study by Public Health England and University College London found that the likelihood of general practitioners prescribing antibiotics for coughs and colds increased by 40% between 1999 and 2011 (Hawker J et al Trends in antibiotic prescribing in primary care for clinical syndromes subject to national recommendations to reduce antibiotic resistance, UK 1995–2011: analysis of a large database of primary care consultations J. Antimicrob. Chemother. first published online August 4, 2014 doi:10.1093/jac/dku291)

Consequently, there is an urgent need for further evidence to identify the most effective interventions to change the culture of antibiotic prescribing across the healthcare system and to help patients develop better understanding of the proper role of antibiotics.

Timely and appropriate treatment of suspected serious bacterial infection is essential. We need to ensure the right dose of the right drug is provided at the right time. Using antibiotics for the right duration could contribute to a fall in antibiotic prescribing and exposure across the healthcare system.

Research questions identified within this theme include: 

  • What are the most effective and cost-effective individual and community level based social marketing interventions to help reduce inappropriate expectations of antibiotic prescribing. For example; which interventions stimulate sustainable behaviour change across targeted populations (specifically patients, carers and the public), what is the most effective age group to target interventions, what are the most effective messages and what are the most effective tools for different age groups and demographics
  • What interventions are most effective for communicating information on antimicrobial resistance to healthcare workers to promote antibiotic stewardship and improve the quality of antibiotic prescribing?
  • What are the most effective interventions to support enhanced communication skills for healthcare practitioners which lead to a decrease in antibiotic prescribing For example, research could focus on understanding the dynamics of antibiotic use in care homes, including the role of prevention of infection and prescribing of antibiotics and how these are driven by care staff, patients, relatives and GPs.
  • Studies for de-escalation of treatment of clinical infections in primary and secondary care to look at avoidance of antibiotic use, reducing dose or duration or changing from broad spectrum to selective antibiotics as soon as possible.
  • Can targeted antibiotic strategies be used more effectively on intensive therapy units (ITU)?
  • How can the occurrence of Gram-negative HCAI in the hospital settings be reduced? E.g. what is the contribution from; early identification of colonized patients, individual patient decolonization and shorter durations or dosage of antibiotic prescribing?
  

Theme 3: Diagnostics and New Technologies - New treatments and technologies which contribute to a reduction in antimicrobial resistance

Whilst the conservation of existing antimicrobials is essential, it is vital that we have new antibiotic therapies available for the future. It will be imperative to ensure the better targeting of new and existing therapies and to monitor the spread of drug resistant infections. New diagnostic technologies, such as whole genome sequencing, have the potential to help improve patient outcomes, promote responsible use of antimicrobials and through rapid identification and characterisation of resistant bacteria reduce the use of broad spectrum antibiotics.

Research questions identified within this theme include: 

  • How do we ensure the cost effective use of molecular diagnostics in primary and acute care settings?
  • How effective are prognostic biomarkers in the management of antibiotic therapy: combinations and clinical assessments?
  • How can new diagnostic research contribute best to improving patient outcomes?
  • What are the barriers to the use of existing diagnostic tests for infections and how can they be reduced?
  

How to apply

Research proposals must be within the remit of one of the participating NIHR programmes (as listed in the table above) and applicants should carefully consider the remit described for each programme. However, this call provides opportunities to evaluate interventions which cross NIHR programme boundaries and applications which span the remit of one or more NIHR programme will be considered. The inclusion of patient views and experiences are considered important by each participating programme.

The NIHR is not running a separate competition for antimicrobial resistance research; applications will be considered by the participating programmes’ alongside other research applications in the normal way. Application forms will be available from the participating programmes’ websites in due course.

Please note that submission dates vary and completed forms must be submitted by the date specified on the application.