The aim of ARTE is to deliver effective antimicrobial therapy by providing a bench-to-bedside platform for state-of-the-art research, education and training in antimicrobial resistance and therapeutics. This aim is driven by the current problems faced by society and individual patients with respect to the growing threat of global antibiotic resistance.
Research Activities
The primary aim of research of ARTE is to provide a platform for research in antimicrobial resistance and therapeutics in all its aspects from bedside to bench and from bench to bedside and is therefore by definition multidimensional and multidisciplinary. This iterative thinking is the guideline at all four levels :
DIT IS EEN TEST
Clinical – where A(ntibiotic)-teams provide advice to clinicians, development of software to increase quality of care, clinical decision support, optimize antimicrobial treatments, and improving diagnosis, e.g. by the development of Point-of-Care tests.
Epidemiological – by mapping the carriage of antibiotic resistance genes and identify risk factors for acquisition, carriage and spread/transfer of these resistance genes and is supported by molecular typing techniques.
Fundamental – by studies into e.g. antibiotic resistance mechanisms, development of new antibiotics, novel treatment strategies, virulence, host and microbe interactions.
Translational – by development of clinical implementation strategies including pharmacokinetic/-pharmacodynamic antibiotic studies in vitro and in vivo model systems and patients, and the validation of new rapid/POCT diagnostic devices/techniques.
ARTE performs research with local, national and international partners and is an active member of the Netherlands Centre of OneHealth. ARTE participates and initiates in international research collaborations (e.g. PreDiCT-TB, TAILORED, DIAGORAS) and is coordinator of large EU projects (e.g. AIDA, CO-ACTION, NABARSI).
Collaborations
ARTE performs research with local, national and international partners and is an active member of the Netherlands Centre of OneHealth. ARTE participates and initiates in international research collaborations (e.g. PreDiCT-TB, TAILORED, DIAGORAS) and is coordinator of large EU projects (e.g. AIDA, CO-ACTION, NABARSI).
Contributions
ARTE is involved in education at all levels at the Erasmus MC and its partners : the BSc program in Medicine Theme Infection & Immunity, BSc contribution to several other Themes, the Medical Delta BSc program Clinical Technology, and the Erasmus University College BSc program Life Sciences. At the MSc level, ARTE participates in the MSc Research program Infection & Immunity in the Postgraduate School Molecular Medicine. There are currently 19 PhD students in different areas within ARTE. Education is not limited to the Erasmus MC: national high level courses are organized to increase awareness of antibiotic resistance and the therapeutic options. Furthermore, members of ARTE have a long standing tradition of internationalisation by organizing and participating in courses at the EU level. ARTE currently provides more than 50 minors all over the world, with a strong focus on developing countries. There are strong bonds with several Indonesian Universities and faculties including exchanges of students. Ties with Indian Institutions are strengthened. The higher education and specialization of medical specialists in medical microbiology as well as infectious diseases is in a unique position that they are trained in the same department. There is no other similar situation elsewhere in the country.
Care Activities
ARTE has the objective of providing improved care for the following groups of ROBIJN-labelled patient populations: intensive care patients; patients where research is closely associated with patient care, multi-specialism care patients; patients presenting with rare diagnoses; patients who are referred to Erasmus MC by medical specialists and patients younger than 50 years of age presenting with 3 or more diseases.
According to VBHC criteria, quality improvement generated health outcomes are powerful drivers of cost containment and value improvement. In this respect, ARTE helps promote the following quality improvements: early detection, correct diagnosis, correct treatment to the correct patient; and treatment earlier in the causal chain of disease. Further, our emphasis on preventing the inappropriate use of antibiotics and reducing the appearance of antibiotic resistance fits well with the statements that 'Better health is the goal, not more treatment' and 'Better health is inherently less expensive than poor health'.
ARTE currently researches into the current and future threats of antibiotic-resistant pathogens, rapid and Point-of-Care diagnostics, as well as the development of new antibiotics and treatments. Further, advice is provided by our Antimicrobial Stewardship Teams. The Unit Diagnostics Medical Microbiology obtained ISO accreditation in 2013 as a first in The Netherlands.
Societal Relevance to Research, Education and Patient Care
In the recent O'Neill report from the UK government antimicrobial resistance was recognized as the most important threat to human medicine with an impact in all areas of patient care, but also in veterinary medicine and related fields. The Erasmus MC has recognized this by active participation in the recently founded Netherlands Centre of One Health (NCOH). ARTE will play an important role in the NCOH.
On a national level, members of ARTE are strongly represented in the SWAB, the Dutch Society for the prudent use of Antibiotics, chairing the SWAB as well as the AMR working group. The guidelines of the SWAB are leading in the Netherlands in antimicrobial therapy and the continuing development of SWAB-ID – a web based formularium used by more than half of the hospitals in The Netherlands was developed with its roots in the EMC.
Several participants have leading positions in the Dutch Working Party on Infection Prevention (WIP) in particular with respect to emerging resistance. Members of ARTE are active in the European arena as well and have several leading positions, including chair of membership of the committee that sets guidelines for interpretation of susceptibility testing and therefore use of antibiotics in patients and society.
Viability of Research, Education and Patient Care
ARTE will allow an increase in the viability of research, education and patient care. Members of our ACE are working in several disciplines, with a good mix between the young and the old.
Our ACE has shown the potential for attracting new people at all levels including students, basic scientists, molecular and medical biologists and medical doctors. At present there are several international PhD students (Indonesia, Australia, Spain) as well as Post-docs and senior scientists (Greece, Italy).
PhD students are encouraged to follow international courses and/or gain experience abroad during their training. International networking is key to the success of the ACE; at present we participate in many large EU and JPI-AMR projects. Over the last 3 years more than 200 publications with representative authors from more than 30 countries show the international focus.
Key and relevant publications of the last five years
- Mouton JW, Ambrose PG, Canton R, Drusano GL, Harbarth S, MacGowan A, Theuretzbacher U, Turnidge J.Conserving antibiotics for the future: new ways to use old and new drugs from a pharmacokinetic and pharmacodynamic perspective. Drug Resist Updat. 2011 Apr; 14:107-17
- McCarthy AJ, van Wamel W, Vandendriessche S, Larsen J, Denis O, Garcia-Graells C, Uhlemann AC, Lowy FD, Skov R, Lindsay JA. Staphylococcus aureus CC398 clade associated with human-to-human transmission. Appl Environ Microbiol. (2012),78:8845-8
- de Steenwinkel JE, Aarnoutse RE, de Knegt GJ, ten Kate MT, Teulen M, Verbrugh HA, Boeree MJ, van Soolingen D, Bakker-Woudenberg IA. Optimization of the rifampin dosage to improve the therapeutic efficacy in tuberculosis treatment using a murine model. Am J Respir Crit Care Med. 2013 May 15; 187:1127-34
- de Steenwinkel JE, ten Kate MT, de Knegt GJ, Kremer K, Aarnoutse RE, Boeree MJ, Verbrugh HA, van Soolingen D, Bakker-Woudenberg IA. Drug susceptibility of Mycobacterium tuberculosis Beijing genotype and association with MDR TB. Emerg Infect Dis. 2012 Apr; 18:660-3
- Islam MA, Talukdar PK, Hoque A, Huq M, Nabi A, Ahmed D, Talukder KA, Pietroni MA, Hays JP, Cravioto A, Endtz HP. Emergence of multidrug-resistant NDM-1-producing Gram-negative bacteria in Bangladesh. Eur J Clin Microbiol Infect Dis. 2012 Oct; 31:2593-600
- Khan MA, van der Wal M, Farrell DJ, Cossins L, van Belkum A, Alaidan A, Hays JP. Analysis of VanA vancomycin-resistant Enterococcus faecium isolates from Saudi Arabian hospitals reveals the presence of clonal cluster 17 and two new Tn1546 lineage types. J Antimicrob Chemother. 2008 Aug;62: 279-83
- Muller AE, Punt N, Mouton JW. Optimal exposures of ceftazidime predict the probability of microbiological and clinical outcome in the treatment of nosocomial pneumonia. J Antimicrob Chemother. 2013 Apr; 68:900-6.
- Menezes GA, Harish BN, Khan MA, Goessens WH, Hays JP. Antimicrobial resistance trends in blood culture positive Salmonella typhi isolates from Pondicherry, India, 2005-2009. Clin Microbiol Infect. 2012 Mar; 18:239-45
- Mouton JW, Brown DF, Apfalter P, Cantón R, Giske CG, Ivanova M, MacGowan AP, Rodloff A, Soussy CJ, Steinbakk M, Kahlmeter G. The role of pharmacokinetics/pharmacodynamics in setting clinical MIC breakpoints: the EUCAST approach. Clin Microbiol Infect. 2012 Mar;18(3):E37-45
- EUCAST expert rules in antimicrobial susceptibility testing.Leclercq R, Cantón R, Brown DF, Giske CG, Heisig P, MacGowan AP, Mouton JW, Nordmann P, Rodloff AC, Rossolini GM, Soussy CJ, Steinbakk M, Winstanley TG, Kahlmeter G.Clin Microbiol Infect. 2013 Feb;19(2):141-60.
- Martin Stocker, Wendy van Herk, Salhab el Helou et al, Efficacy and safety of Procalcitonin-guided decision making for duration of antibiotic therapy in neonates suspected of early-onset sepsis: the NeoPInS study – an international, multicentre, non-inferiority randomised controlled intervention trial. Lancet. 2017; 390: 871-881.
PhD theses of the last five years
- Lebon A Bacterial colonisation of the nasal and nasopharyngeal cavities in children. The Generation R study Promotoren: Prof. dr. H.A. Moll, Prof dr. dr. A. van Belkum PhD Thesis EUR Rotterdam; (T1), 16th March 2011
- Verhaegh SJC Epidemiology and pathogenesis of Moraxella catarrhalis colonization and infection Promotor: Prof. dr. dr. A. van Belkum Co-promotor: Dr. J. Hays PhD Thesis EUR Rotterdam; (T1), 1st June 2011
- Willemse-Erix D Optical fingerprinting in medical microbiology. Raman Spectroscopy as a bacterial typing tool Promotor: Prof. dr. dr. A van Belkum Co-promotor: Dr. K. Maquelin PhD Thesis EUR Rotterdam; (T1), 10th November 2011
- Witt R te Clinical microbiological diagnostics 2.0 Promotor: Prof. dr. dr. A. van Belkum Co-promotor: Dr. W.B. van Leeuwen PhD Thesis EUR Rotterdam; (T1), 15th June 2012
- Steenwinkel JEM de PREDICT TB; Prevention of Resistance, Evaluation of Diagnostics and Intensified or Custom-made Treatment of Tuberculosis Promotor: Prof. dr. H.A. Verbrugh Copromotor: Dr. I.A.J.M. Bakker-Woudenberg PhD Thesis EUR Rotterdam (T1), 16th No
- Bruins M Transferable Odor Differentiation Models for Infectious Disease Diagnostics Promotor: Prof. dr. A. van Belkum Co-promotoren: Dr. W.W.J. van de Sande, Dr. A. Bos PhD Thesis EUR Rotterdam; (T1), 28th February 2014
- Bruin J Legionella: the Need for Culture Promotor Prof. dr. J.W. Mouton Thesis RUN Nijmegen. 27th November 2014
- Bruins M Transferable Odor Differentiation Models for Infectious Disease Diagnostics Promotor: Prof. dr. A. van Belkum Co-promotoren: Dr. W.W.J. van de Sande, Dr. A. Bos PhD Thesis EUR Rotterdam; (T1), 28th February 2014
- Berg van den S Improving diagnosis and treatment of Staphylococcus aureus infections Experimental Studies Promotor: Prof. dr. H.A. Verbrugh Co-promotor: Dr. I.A.J.M. Bakker-Woudenberg PhD Thesis EUR Rotterdam; (T1), 14th January 2015
- Farida H Community-acquired pneumonia in Indonesia Promotoren: Prof. dr. H.A. Verbrugh, Prof. P.J. van den Broek Co-promotoren: Dr. J.A. Severin, Dr. M. Hussein Gadem PhD Thesis EUR Rotterdam; (T1, T2), 22nd April 2015