1. GENOMICS TO COMBAT RESISTANCE AGAINST ANTIBIOTICS IN COMMUNITY-ACQUIRED LRTI IN EUROPE (GRACE) H. Goossens (Coordinator), K. Loens (Manager), M. Ieven (Lab. Network Support), S. Coenen (PC Network Support), C. Lammens (Tech Support), A. Struyven (Administrator) Background: Community-acquired lower respiratory tract infections (LRTI) are the leading reason for seeking medical care and consuming antibiotics. Objectives: The overall aim of GRACE is to combat antimicrobial resistance through integrating and strengthening centres of excellence for studying the application of genomics with primary care practitioners. Methods: The research program has been divided into four platforms (fig. 1): GRACE- COMIT for coordination, management and information technology, GRACE-TECH for technological developments, GRACE-PAT for patient studies and GRACE-EDUT for education and training. Results: Here we focus on GRACE-COMIT, GRACE-PAT and GRACE-EDUT. More detailed information can be found in the GRACE Leaflet (fig. 2) or on the GRACE website (www.grace-lrti.org). Figure 3: The first three issues of GRACE News Figure 2: The GRACE LeafletFigure 1: The GRACE Platforms GRACE-COMIT, platform for coordination, management and information technology: - A 3-monthly newsletter is reporting on the progress of GRACE activities (fig. 3). - A GRACE Online System (GOS) was set up by Robert Veen and his team at the University Medical Centre in Utrecht (fig. 4). Figure 5: The GRACE network and site visit dates for WP8 and WP9-10 (in red) GRACE-PAT, platform for patient studies: WP8, led by Chris Butler and his team at Cardiff University: - A network of 14 primary care networks in 12 European countries is established (fig. 4&5). - GRACE-01, registered at www.clinicaltrials.gov as NCT00353951, is the largest observational study of current practice in community-acquired LRTI ever undertaken with an inclusion rate of over 3,000 patients. - GRACE-02, a qualitative study, aims to assess the opinions and expectations of both physicians and patients regarding LRTI and its management, in order to develop a deep understanding of the variation we expect to find in presentation, practice and outcomes. - GRACE-03 aims to produce and disseminate evidence-based definitions of major LRTIs. www.grace-lrti.org Figure 4: GRACE Online System: Inclusions per primary care network (20/03/’07) Figure 6: Announcements of the GRACE postgraduate courses & workshops This project is supported through Priority 1 (Life Sciences, Genomics and Biotechnology for Health) of European Union's FP6, Contract number: LSHM-CT-2005-518226 WP9, led by Theo Verheij and his team at the University Medical Centre in Utrecht: -The microbiological etiology of LRTI and bacterial resistance rates will be studied in 3000 healthy controls and 3000 adults with LRTI in collaboration with GRACE-TECH. -A diagnostic study will be done in the 3000 cases. The aim is to develop diagnostic models to help clinicians better predict bacterial infections and pneumonia. - A prognostic study will be performed in (the same) patients with LRTI six weeks after inclusion. The aim is to develop a prognostic model that would help primary care physicians to discriminate between patients with a high and patients with a low risk for poor outcome. WP10, led by Paul Little and his team at the University of Southampton: - A trial will be nested in the observational studies of WP9 and study the effects of antibiotic treatment (amoxicillin 1g TID) compared with placebo in 3000 subjects with LRTI. ABSTRACT GRACE is a Network of Excellence focusing on the complex and controversial field of community-acquired lower respiratory tract infections (LRTI), which is one of the leading reasons for seeking medical care. The promiscuous use of antibiotics to treatment of LRTI accounts for a major part of the community burden of antibiotic use and contributes dramatically to the rising prevalence of resistance among major human pathogens. The overall objective of GRACE is to combat antimicrobial resistance through integrating centres of research excellence and exploiting genomics in the investigation of community-acquired LRTI. Microbial and human genomics will be integrated with health sciences research consisting of clinical observational and intervention studies, health economics and health education to specifically change practice in managing community-acquired LRTI. In the jointly executed research programme, 18 academic groups, spread widely across 9 EU Member States and 4 SMEs will participate. GRACE will organise professional education, including web-based teaching and practical courses, through two leading European scientific societies (European Society of Clinical Microbiology and Infectious Diseases and European Respiratory Society) to disseminate the excellence of the programme. A high level of co-ordination will be obtained through a professionally IT-supported and rigorous management structure. The network will receive €11.5 million from the EU’s 6th Research Framework Programme and will run until at least 2011. GRACE-EDUT, platform for education and training: This work is led by Francesco Blasi (ERS) and Roger Finch (ESCMID): - A GRACE e-learning platform at www.ersnet.org/grace. - Postgraduate courses and workshops (fig. 6) to inform postgraduate lifelong learning needs of prescribing professionals.