Post Detail

An orientation meeting to review the draft protocol for the Burden of Disease (BOD) study under the CAPTURA II/TACE project was held at the National Academy of Medical Sciences, Bir Hospital, on 24 June 2025. Officials from the Ministry of Health and Population, the hospital director, clinicians, public health experts, and representatives from partner organisations came together to discuss the upcoming study focused on antimicrobial resistance (AMR) in Nepal.

The BOD protocol will be implemented at two hospitals: Bir Hospital and Seti Provincial Hospital. Representatives from Seti Provincial Hospital participated virtually from Dhangadhi. The meeting aimed to present the draft protocol, collect feedback from the study sites, and ensure alignment among all stakeholders before seeking ethical approval and starting the study.

The study, titled Feasibility and Estimation of AMR Burden using ACORN-lite, aims to estimate the burden of drug-resistant infections, particularly bloodstream infections (BSIs), using an adapted version of the ACORN method. The Clinically-Oriented Antimicrobial Resistance Surveillance Network (ACORN) is a case-based human AMR surveillance approach that captures clinical and microbiology data. The data collected includes clinical variables and patient outcomes, helping to improve global understanding of AMR.

The ACORN-lite protocol incorporates lessons learned from the earlier pilot and second phase (ACORN2). Improvements include expanding patient groups, adjusting case identification procedures to be based on isolates rather than clinical infections alone, and optionally storing bacterial isolates for molecular or Whole Genome Sequencing (WGS). It builds upon the WHO’s Global Antimicrobial Resistance Surveillance System (GLASS), extending it to include clinical outcomes, the origin of infection (community or hospital), and patient demographics.

Dr Nimesh Poudyal, Senior Research Scientist at the International Vaccine Institute (IVI), presented the draft protocol. He explained that the study will generate evidence about the health and economic impacts of AMR and will evaluate how feasible it is to integrate the ACORN-lite model into routine hospital systems in Nepal. Both Bir Hospital and Seti Provincial Hospital will pilot this study. There will also be an optional component, subject to capacity and consent, for storing bacterial isolates for future WGS analysis to better understand resistance patterns.

Bir Hospital strongly supported the study and emphasised the importance of obtaining ethical clearance for all aspects, including those currently optional. Hospital staff highlighted the urgent need to address AMR in Nepal, where the scale of the issue remains largely unknown.

Seti Provincial Hospital also welcomed the initiative but noted operational challenges, including limited blood-culture practices, low awareness of AMR among clinical staff, and inconsistent adherence to national treatment guidelines. They requested support in staff training, improved infection prevention and control (IPC), and enhanced coordination with provincial and national health authorities.

The IVI team reaffirmed their ongoing support for both hospitals, pledging technical assistance, training, and resources to strengthen AMR surveillance and hospital capacity. Ms Tandukar from the Ministry expressed full support for the study’s implementation and hoped other hospitals would follow the example set by these sites, contributing to stronger nationwide AMR surveillance.

Feedback from this meeting will be incorporated into the final protocol, which will then be submitted for ethical review through Anweshan.

Next Steps Include:

• Finalising the protocol based on stakeholder feedback.
• Starting the ethical approval process.
• Developing capacity-building plans specific to each site.
• Holding follow-up meetings to support implementation readiness.

This orientation meeting was an important step in improving Nepal’s ability to understand and address antimicrobial resistance. Supported by dedicated partners, hospital teams, and coordinated efforts from CAPTURA II/TACE and IVI, the study will provide important data that can inform national policy and improve patient care.

By building strong evidence, Nepal is moving toward a better prepared and more effective health system in the fight against AMR.