Implementing clinical bacteriology in low resource settings: reviving the old, bringing in the new

Low resource settings (LRS) are disproportionally hit by antimicrobial resistance but face serious infrastructural, technical and human challenges when implementing clinical bacteriology; among these challenges, we identified appropriate “tropicalized” (i.e. environmentally stable, simple and user-friendly) techniques and embedment in clinical care as priority requirements. The objective of the present PhD proposal is to provide scientific evidence to support implementation of clinical bacteriology in LRS while addressing these priorities.
It consists of four work packages:
(1) Optimization and validation of tropicalized, manual (non-automated) culture-based techniques for laboratory diagnosis and antibiotic susceptibility testing of bacteria causing bloodstream infection in LRS
(2) Optimization and validation of user-friendly, equipment-free “spot-tests” for bench identification and detection of resistance among clinically relevant bacteria causing bloodstream infection in LRS
(3) Indicator-based monitoring of diagnostic and antibiotic stewardship achieved through the implementation of a small-scale and stand-alone clinical bacteriology laboratory (“MSF Minilab”) in LRS
(4) Field adoption study of a new in-vitro diagnostic tool for detection of bloodstream infections in LRS, including assessment of diagnostic and operational performance, barriers to adoption, embedment in patient care and clinical utility.
The proposal is aligned with the Médecins Sans Frontières-initiated “Minilab” project, a recently started-up project consisting of a small-scale, low-cost, clinical bacteriology laboratory with simplified and harmonized procedures, fit for deployment in LRS and commanded by non-expert laboratory staff. The proposal fits into the Institute of Tropical Medicine interdepartmental track “Bacterial Infections in the Tropics”.
The project will strengthen the implementation of clinical bacteriology in LRS leading to (1) improvement of individual patient care, (2) surveillance of antimicrobial resistance and (3) support to infection control activities and microbiological outbreak assessment.
In addition, a considerable operational impact will be obtained through (1) education: Short Course on Clinical Bacteriology in LRS, open-access manuals, website, video trainings (2) prototype IVDs with intellectual property rights that protect them as a public good in LRS (3) service delivery within international disease control networks (cholera, invasive salmonellosis) (4) advocacy through collaboration with MSF and its Minilab network