ADRESA (Addressing Drivers of Resistant Sepsis in Africa)

Sepsis is a frequent cause of death in low income countries, particularly in neonates and young children. Although the global burden from most infectious disease has declined very significantly, that from neonatal sepsis has remain unchanged [1]. A study in Kenya in 2005 found that community-acquired bacteraemia is responsible for 26% of child deaths in hospital [2].

The Kenyan government has a national action plan for containment and prevention of antimicrobial resistance [3]. Key objectives include (a) to understand the state of AMR emergence and prevalence, and use of antimicrobials (including surveillance and monitoring) and (b) to accelerate research on the mechanism of AMR emergence and transmission, and its impact on social economy.

This project will provide better understanding of the importance of the key elements that drive resistant sepsis in Kenya, including prescribing, farming and agricultural practices, the prescribing of drugs, wastewater and sewage treatment, the provision of fresh water, factory outflow and pollution, the persistence of asymptomatic carriers in the populations, etc.

Through a better understanding of the drivers of antibiotic resistance and their relative importance, it will be possible to design better targeted interventions to address this problem. At present the Kenyan National Action Plan is very broad, involving all possible drivers of antibiotic resistance, but it will be difficult to achieve all of these objectives with limited resources. By understanding the key drivers of antibiotic resistance, it will be possible to target resources at the priority individual and structural levels. This will result in a clear strategy for implementing change and reducing the health impact of antibiotic resistance, which we will develop in close collaboration with the Kenya Ministry of Health. The process we develop will also be applicable and replicable in other Low- and Middle-Income Countries, (LMICs), and during the development phase of the project we will explore links with other LMICs in sub-Saharan Africa, as well as assessing the need for research capacity development both in Kenya and in other potential partner countries. 

Our multidisciplinary consortium includes experts from a range of disciplines:

1. Clinical practice and human use of antibiotics: Prof Paul Little and Prof Rob Read, UoS; Dr Sam Kariuki and Dr Maritim, KEMRI
2. Community surveys in LMICs and epidemiology: Prof Nuala McGrath, Dr Merlin Willcox, UoS; Dr Sam Kariuki and Dr Thumbi Mwangi, Kenya Medical Research Institute (KEMRI)
3. Veterinary use of antibiotics: Dr Thumbi Mwangi, KEMRI; Dr Mark Holmes, Cambridge
4. Microbiology and antibiotic resistance in bacteria: Prof Rob Read, UoS
5. Genetic epidemiology of bacteria: Dr Mark Holmes, University of Cambridge
6. Environmental microbiology: Prof Huw Taylor, University of Brighton
7. Environmental chemistry (measuring antibiotic levels in the environment): Prof Alistair Boxall, University of York
8. Geospatial data processing and analysis: Prof Jim Wright, UoS
9. Statistics and multilevel spatial modelling: Prof Alistair Boxall, University of York

Professor Leighton, Chair of Global-NAMRIP said “I was very pleased that NAMRIP could support pump-priming activities for this very important project, and will work hard with the team to ensure that it can realise its full potential, and execute the full research plan to help with the delivery of the Kenyan National Action Plan for AMR.”