TRACS-Liverpool is a mixed methods programme of research that is looking at how antimicrobial resistance is acquired and transmitted within and across care settings in Liverpool.
Antimicrobial resistance (AMR) threatens the effectiveness of antibiotics that are widely used in modern medicine. Some resistant bacteria pose a particular threat, namely a group called Enterobacterales. These bacteria become resistant to antimicrobials when they acquire genes that enable the bacteria to produce enzymes that destroy antibiotics. People frequently carry these resistant bacteria without knowing. But in some cases they cause illness that can be life threatening or untreatable.
Although we understand how people can acquire these bacteria – either through direct exposure, such as swallowing them, or through exposure to antibiotics; it is less clear when and how these resistant bacteria are transmitted. We know that people requiring frequent hospital admissions, or who live in long term care facilities are at particular risk of acquiring resistant bacteria. We also know that rates of antimicrobial resistance are higher in the north-west than in the rest of the UK.
There are 3 planned stages of research:
1) A qualitative study outlining the current system of hospital and residential care in Liverpool including examining care “journeys” and interviewing key stakeholders across care settings to gauge their opinions about AMR and the proposed research study.
2) An observational cohort study during which participants will be recruited from 6 sites across Liverpool (hospital wards and care homes), stool samples collected and cultured for resistant Enterobacterales bacteria. Samples will also be collected from the hospital and care environment and from staff. Where found, gene sequencing techniques will be used to track where these bacteria may have come from. This information will be used to map and identify places where people acquire resistant bacteria, and to design interventions to block transmission.
This stage will include repeated sampling and will last approximately 18 months.
3) Lastly, depending on the emerging results of the cohort study, an intervention to interrupt transmission will be proposed and trialed in a care environment, alongside qualitative work to determine the acceptability of the intervention.