Ineos Oxford Institute concludes data collection for two major global AMR studies

The Ineos Oxford Institute for antimicrobial research (IOI), which spans the Departments of Biology and Chemistry at Oxford, has completed data collection for two global studies investigating antimicrobial resistance (AMR). Over 135,000 patients from 17 hospitals in seven low-and-middle income countries were screened for bloodstream infections and over 24,000 bacterial isolates have been collected for analysis.

AMR, a process in which microbes like bacteria and fungi stop responding to treatment, does not affect every country equally. In South Asia and the Middle East, one in three infections are resistant to antibiotics, and by 2050 up to 90% of all AMR-related deaths are expected to occur in low- and middle-income countries.

Researchers at the IOI are working with partners in low-resource countries to track how antibiotic-resistant bacteria spread, and how they affect patient recovery and survival. The evidence they generate will support hospitals and governments to strengthen infection control, guide antibiotic use, and protect the patients most at risk.

Through two clinical infection surveillance programmes, BARNARDS and BALANCE, clinicians were provided access to free blood culture testing and antimicrobial susceptibility reporting. These tests helped clinicians confirm the presence of bacteria or fungi in the blood and identify which antibiotics would most likely treat the infection. This enables doctors to prescribe effective treatments more quickly.

Bacteria and fungi obtained from blood culture samples have now also been shipped to Oxford, where researchers are currently undertaking detailed laboratory and genomic analysis. Genomic analysis examines the DNA of bacteria to understand how resistance develops and spreads. The results will provide regional, country and hospital-specific data on resistance patterns, and inform improved treatment strategies.

Together, these collected samples form two of the most comprehensive sets of bacterial isolates recovered from bloodstream infections across multiple lower-middle income settings.

Professor Tim Walsh, Director of Biology at the Ineos Oxford Institute for antimicrobial research said:

“From the get-go, we wanted to address the massive gaps in understanding the burden of serious diseases in those populations most afflicted by antimicrobial resistance, and which incidentally, will be those hit hardest by climate change. These studies represent one of the largest coordinated efforts to understand the burden of antimicrobial resistance in low- and middle-income countries. The findings will support better clinical decision making, add to national databases to facilitate modelling studies, strengthen national policy, and ultimately improve patient outcomes.

None of this would have been possible without the tenacity, leadership and plasticity of our partners across all participating countries, who to a person have been magnificent. This is a truly collaborative achievement.”

BALANCE: the most comprehensive global study estimating burden of antimicrobial resistance

Bloodstream infections, including sepsis are a life-threatening condition that occur when infectious bacteria or fungi enter the bloodstream and trigger a systemic inflammatory response. Early diagnosis and appropriate antibiotic treatment are critical to prevent disease progression and improve survival and clinical outcomes.

IOI’s BALANCE study connects researchers, clinicians and hospital staff across 17 sites in 7 countries to strengthen local research in low-resource settings, gather region-specific data on bacterial resistance, and enable doctors to select the most efficient antibiotics for their patients.

Researchers have screened over 67,000 patients, taking blood samples for on-site microbiology and blood culture testing. Approximately 9,000 bacterial and fungal isolates were recovered from confirmed bloodstream infections.

The analysis integrates clinical, demographic, socioeconomic, and molecular data to estimate the burden of antimicrobial resistance in both adult and paediatric populations. By incorporating patient factors (such as severity of illness), treatment outcomes (treatment failure associated with resistant infections), and pathogen characteristics, BALANCE uniquely compares outcomes among patients with resistant bloodstream infections, susceptible infections, and those without bloodstream infections to provide a comprehensive assessment of AMR burden. Bacterial samples gathered from infected blood are also shared with the IOI’s drug discovery team, to support testing of new antimicrobial drug candidates.

Dr Refath Farzana, BALANCE Scientific Lead at IOI said:

“We have observed substantial variation between hospitals—not only in the bacteria causing infections, but also in antibiotic prescribing practices for bloodstream infections, levels of resistance, and patient mortality. There is no one-size-fits-all solution to antimicrobial resistance. Our approach is therefore tailored to each hospital’s specific epidemiology, clinical needs, and capacity to ensure meaningful and sustainable impact.”

BARNARDS: working to assess the burden of antibiotic-resistant neonatal sepsis

Every year, more than 200,000 newborn babies die from sepsis. Around 90% of global new born deaths occur in low-resource settings. IOI’s BARNARDS is identifying incidence rates of sepsis, resistance levels, and outbreaks patterns.

More than 68,000 patients from 13 hospital sites in 3 countries are enrolled in the study. With access to free blood culture tests, clinicians have gathered over 15,000 bacterial sepsis cultures for further study in the UK. The study recorded clinical meta-data, antibiotic use and clinical outcomes for each case, with a 28-day follow-up for each case to assess antibiotic effectiveness and appropriateness.

While laboratory analysis in Oxford is still ongoing, hospitals have reported that the study has reduced new-born deaths, improved awareness about neonatal infection prevention amongst parents and strengthened capacity and training for local doctors. improved awareness about neonatal infection prevention amongst parents and strengthened capacity and training for local doctors.

There are also several sub-studies within this project, one of which processed 1,800 hospital surface swabs to assess the bacterial environment around patients. Another study examined approximately 1,600 faecal samples to characterise the gut microbiome in infants and study the acquisition of AMR genes.

Dr Katy Thomson, BARNARDS Scientific Lead at IOI, said:

“BARNARDS II has created one of the largest AMR surveillance datasets on neonatal sepsis in low-and-middle income countries. We are now working to turn this complex data into decision-ready evidence to inform policy. We have observed extremely high rates of antimicrobial resistance in this study, highlighting the need for wider access to local diagnostics to guide treatment. High AMR alongside inconsistent antibiotic availability highlight barriers to effective and accessible treatment, reinforcing the need for global investment in accessible diagnostics and essential medicines.”

With data collection complete, IOI researchers are now analysing what is one of the most detailed AMR datasets generated across diverse low- and middle-income settings. Researchers will translate this unprecedented dataset into practical, evidence-based recommendations. By combining surveillance, laboratory science and clinical insight, IOI aims to provide insight to support strengthening of healthcare systems and reduce the global burden of antimicrobial resistance.

To read more about findings from the data collected so far, visit: