On 1 July 2021, the EU-funded REVERSE project – pREVention and management tools for rEducing antibiotic Resistance in high prevalence SEttings – was launched as part of the EU Research and Innovation program, Horizon 2020. 

The overarching goal of REVERSE is to develop and implement cost-effective strategies and tools for the prevention and clinical management of healthcare-associated infections (HAIs) due to multidrug-resistant pathogens, and to reduce the burden of antimicrobial resistance (AMR) in high prevalence care settings.

REVERSE will explore, develop and validate three complementary intervention programmes for the prevention and management of infections due to AMR pathogens (see figure): 

• Microbiology and Diagnostic Stewardship (MDS) Programme 
• Infection Prevention and Control (IPC) Programme
• Antibiotic Stewardship (ABS) Programme

Individually, these intervention programmes and their components are known to contribute to the reduction of the clinical and public health burden of AMR, however there is limited evidence on how these programmes reinforce each other or how to choose and implement the optimal combination of elements in different healthcare contexts. 

Each of these clinical intervention programmes will adopt a multimodal and tiered approach. To introduce them into routine practice, a randomised implementation trial will be conducted to compare them with an enhanced implementation strategy. The implementation activities will be tailored to address determinants in the local context versus a basic implementation strategy.

The outcome will be an integrated, multifaceted package of interventions together with a validated implementation strategy to reduce the burden of AMR in hospitalised patients in settings with high AMR prevalence.

The three intervention programmes and two multifaceted implementation strategies will be evaluated in a large international type-2 hybrid effectiveness-implementation trial. The clinical trial will be conducted in 24 hospitals in Greece, Italy, Romania, and Spain where a high prevalence of infections due to AMR pathogens are evident. 

Results from the clinical study, integrated with existing evidence from hyper-endemic settings, will inform cost effectiveness analyses and produce evaluated intervention options that can be implemented in a range of economically diverse healthcare settings. The project will ensure data dissemination through integrated WP management, educational events and workshops, and participation in national and international meetings. 

Long term sustainability will be pursued by making partner hospitals reference centres, creating national networks where the partner hospitals are the starting points, and integrating relevant national societies and major international stakeholders in healthcare in the process of dissemination. 

Clinical Research Networks

REVERSE will be positioned as one of the independent partner projects in the clinical research portfolio of ECRAID (European Clinical Research Alliance on Infectious Diseases). 

ECRAID will provide sustainability for the clinical research networks and infrastructures funded through COMBACTE and PREPARE.

REVERSE will connect with the infrastructures and processes built in COMBACTE / ECRAID. The clinical studies will be conducted in several hospitals and institutions that are currently part of COMBACTE’s clinical network CLIN-Net. This will allow the selection of the most appropriate sites for the trials. REVERSE will build on COMBACTE’s extensive expertise in conducting clinical trials related to AMR, leveraging EU investments in this important field of research.