The ICU is an important venue for the acquisition and transmission of antimicrobial resistance (AMR).  It also provides a unique perspective on the risk factors for the development of ICU-acquired infection.  Despite efforts to reduce the risk of ICU-acquired infection through the use of infection control measures such as hand-washing and isolation, and bundled approaches to prevent ventilator-associated pneumonia or catheter-related bacteremia, and to reduce antibiotic pressures through antimicrobial stewardship programs, on any given day, more than half of all ICU patients are assessed to be infected, and more than 70% are receiving systemic antibiotics. International collaboration provides unique and important opportunities to understand the epidemiology of ICU-acquired infection and antimicrobial resistance, and to evaluate strategies to reduce these.

The Antimicrobial Resistance in Intensive Care (AMRIC) program, funded in pilot form by the Joint Programming Initiative on Antimicrobial Resistance (JPIAMR), seeks to develop a globally representative ICU-based network for surveillance of AMR.  Our hypothesis is that a better understanding of geographic variability in rates and bacteriology of nosocomial infection, and in rates of AMR can point to potentially modifiable risk factors. 

The ICU Microbiome project will test the hypothesis that patterns of ICU-acquired infection will reflect the local ICU microbiome, as sampled from water sources, inanimate surfaces, and ventilation systems in the ICU.  Applications have been submitted to the Bill and Melinda Gates Foundation Grand Challenges competition to support preliminary studies in South Africa, India, and Brazil, leveraging expertise in environmental microbiology at the University of Stellenbosch in South Africa.

 Ignacio Martin-Loeches is leading an application to the JPIAMR to build expertise in understanding the lung microbiome and its disruption in critical illness, and to relate these changes to the development of ventilator-associated pneumonia.

The Acinetobacter: A Study of Colonization, Emergence, and Transmission in Intensive Care (ASCETIC) study is seeking funding for a multinational study to test the hypothesis that Acinetobacter can be transmitted to critically ill patients through their exposure to the hospital water supply, and so prevented by minimizing exposure.

InFACT studies in antimicrobial resistance focus on an important international threat to acutely ill patients.  They also provide a unique opportunity to build research capacity in emerging groups in low and middle income countries outside the EU/North America/Australia axis.