The Antibacterial Resistance Leadership Group (ARLG) develops, designs, implements, and manages a clinical research agenda to increase knowledge of antibacterial resistance. The ARLG aims to advance research by building transformational trials that will change clinical practice and reduce the impact of antibacterial resistance and antimicrobial resistance through the following strategies:
- Early clinical evaluation of new antibacterials;
- Comparative effectiveness or efficacy trials;
- Strategy trials to optimize currently licensed antibacterials (dose, duration, need for drug) to reduce the risk of resistance;
- Clinical algorithm testing strategies;
- Treatment-based prevention measures;
- Diagnostics testing in the context of treatment trials, epidemiologic elements, or behavioral modification;
- Effective infection control programs, including surveillance for resistant organisms, outbreak investigation, and antibiotic stewardship to prevent the development and spread of resistant organisms;
- Novel facilities level activities to prevent the development of resistance.
The ARLG has unique scientific and operational assets. The ARLG is facilitated by the Duke Clinical Research Institute (DCRI) and works under the centralized leadership of an Executive Committee and two Principal Investigators, Dr. Vance Fowler, Duke University, and Dr. Henry ‘Chip’ Chambers, UCSF. The ARLG has three separate component centers:
- Leadership and Operations Center (LOC), coordinated by Dr. Heather Cross, ARLG Program Leader, DCRI
- Statistics and Data Management Center (SDMC), directed by Dr. Scott Evans, Harvard University
- Laboratory Center, led by Dr. Barry Kreiswirth, Center for Discovery and Innovation, Hackensack Meridian Health and Dr. Robert Bonomo, Case Western Reserve University
The organizational structure features internationally recognized leaders in the field appointed to Scientific Subcommittees, Special Emphasis Panels (SEPs), and a Mentoring Core which are devoted to priority areas, including:
Gram-negative Bacterial Infections
Antimicrobial Stewardship and Infection Prevention
Gram-positive Bacterial Infections
Diagnostics and Devices
What is antibacterial resistance?
Introduction of antibacterials into the clinic in the 1940s ushered in a new era of medicine and changed the course of history. Many physicians anticipated that infectious disease would be eliminated as a public health problem. Unfortunately, a vast and possibly limitless pool of potential resistance genes naturally occurring in microbial populations has thwarted this goal. Since antibacterials exert a powerful selective pressure, bacteria can easily acquire resistance through mutation or horizontal gene transfer. When resistance emerges, physicians usually turn to alternative agents to continue treating infections, but these are often expensive, less effective and more toxic to patients. In the past few decades this problem has grown as antibacterial discovery has failed to keep up with multiple-drug resistant strains of pneumococci, gonococci, staphylococci, and Gram-negative bacilli (GNB). For more information on antibacterial and antimicrobial resistance efforts by the National Institute of Allergy and Infectious Diseases (NIAID) to address the issue, please visit the NIAID.