Our goal is to create and implement an Antibacterial Resistance Leadership Group (ARLG) that will develop, design, implement, and manage a clinical research agenda that will increase knowledge of and mitigate the important factors that drive resistance. We will pair an unprecedented team of over two dozen of the world's top investigators with the organizational excellence of the Duke Clinical Research Institute (DCRI), one of the world's largest Academic Research Organizations. Because of the complexity of integrating multiple components of such a large-scale clinical research network, our submission features centralized leadership through an Executive Committee and a dual PI approach. One PI (Fowler) focuses primarily on operations and the other (Chambers) focuses largely on scientific agenda. The organizational structure, modeled after that of the ACTG, also features Scientific Subcommittees devoted to four priority areas: Gram-negative bacterial infections, Stewardship and infection prevention, Gram-positive bacterial infections, and Diagnostics and devices. These Subcommittees are supported by three Special Emphasis Panels (SEPs) (Pediatrics, Pharmacokinetics, and Special Populations) and a Mentoring Core. Each Subcommittee, SEP, and Core contains internationally recognized investigators, ensuring expertise. To complement the current research activities of both NIH and the pharmaceutical biotechnology industry, our ARLG has established collaborative ties with members of both communities. Our long-term goals are 1) to complete a superiority trial of new anti-infectives (either new agent or new dosing regimen of existing agent) for MDR-Gram negative bacterial infections;2) to define shorter course, narrow-spectrum therapeutic regimens for common infections as a principal means to support stewardship;3) to test a rapid diagnostic that identifies antimicrobial resistance based on genotypic markers in bacteria;and 4) to identify a more effective alternative to vancomycin for MRSA infections. The research agenda reflects our overall strategy of making realistic, incremental steps in early phase studies upon which to build toward more complex transformational trials that will change clinical practice and reduce the impact of antibacterial resistance.

Public Health Relevance

Antibacterial resistance (AR) is one of the world's top health threats. It is a complex, growing problem. Reducing the burden of AR requires a sustained program that simultaneously addresses critical issues from many perspectives. Our goal is to establish an Antibacterial Resistance Leadership Group (ARLG) that will develop, design, implement, and manage a clinical research agenda to increase knowledge of AR, and to reduce the factors that drive its emergence.

National Institute of Health (NIH)
National Institute of Allergy and Infectious Diseases (NIAID)
Research Project with Complex Structure Cooperative Agreement (UM1)
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Special Emphasis Panel (ZAI1-AWA-M (S1))
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Zou, Lanling
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Duke University
Internal Medicine/Medicine
Schools of Medicine
United States
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Stafford, Kristen A; Boutin, Mallory; Evans, Scott R et al. (2014) Difficulties in demonstrating superiority of an antibiotic for multidrug-resistant bacteria in nonrandomized studies. Clin Infect Dis 59:1142-7
van Duin, David; Perez, Federico; Rudin, Susan D et al. (2014) Surveillance of carbapenem-resistant Klebsiella pneumoniae: tracking molecular epidemiology and outcomes through a regional network. Antimicrob Agents Chemother 58:4035-41
Vazquez Melendez, Elsa L; Farrell, John J; Hujer, Andrea M et al. (2014) Culture negative empyema in a critically ill child: an opportunity for rapid molecular diagnostics. BMC Anesthesiol 14:107
Ramirez, Maria Soledad; Xie, Gang; Johnson, Shannon et al. (2014) Genome Sequences of Two Carbapenemase-Resistant Klebsiella pneumoniae ST258 Isolates. Genome Announc 2:
Wright, Meredith S; Perez, Federico; Brinkac, Lauren et al. (2014) Population structure of KPC-producing Klebsiella pneumoniae isolates from midwestern U.S. hospitals. Antimicrob Agents Chemother 58:4961-5
Asakura, Koko; Hamasaki, Toshimitsu; Sugimoto, Tomoyuki et al. (2014) Sample size determination in group-sequential clinical trials with two co-primary endpoints. Stat Med 33:2897-913
Spellberg, Brad (2014) The future of antibiotics. Crit Care 18:228
Spellberg, Brad; Gilbert, David N (2014) The future of antibiotics and resistance: a tribute to a career of leadership by John Bartlett. Clin Infect Dis 59 Suppl 2:S71-5
Spellberg, Brad (2014) Antibiotic judo: working gently with prescriber psychology to overcome inappropriate use. JAMA Intern Med 174:432-3
Perez, Federico; Hujer, Andrea M; Marshall, Steven H et al. (2014) Extensively drug-resistant pseudomonas aeruginosa isolates containing blaVIM-2 and elements of Salmonella genomic island 2: a new genetic resistance determinant in Northeast Ohio. Antimicrob Agents Chemother 58:5929-35

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