Antimicrobial resistance (AMR) is a growing threat to global health, undermining the effectiveness of life-saving treatments and placing populations at heightened risk, whether from common infections or routine medical interventions (WHO). An estimated 5 million deaths worldwide were associated with bacterial antimicrobial resistance in 2019. AMR rates are particularly high in African countries. Multidrug-resistant (MDR) bacteria are commonly associated with healthcare-associated infections (HAI), with the prevalence of HAI in the WHO African Region estimated to be as high as 27%.

Antibiotic treatment efficacy is severely diminished by the emergence and spread of MDR strains, with a severe lack of alternative treatment options especially in African health settings. Infections with MDR pathogens are associated with high mortality and morbidity due to limited treatment options, as well as increased healthcare costs and length of hospital stay.

The inappropriate use of existing antibiotics and inadequate implementation of infection prevention control measures (IPC) further promote the development of AMR. While AMR is increasingly affiliated with One Health aspects—affecting human, animal, and environmental health—there remain severe data gaps, particularly in low-income settings. This emphasizes the urgent need for further studies to improve our understanding of this complex and critical health threat.

The ASPIRE Consortium has evolved from the COMBAT AMR Network (Comprehensive Multi-Centre Bioinformatics-based Action to Tackle AMR in Sub-Saharan Africa), including six German departments specializing in infectious diseases and tropical medicine and their long-standing partner institutions at university and referral hospitals across five Sub-Saharan African countries. Since 2017, COMBAT AMR focuses on strengthening the interface between microbiological laboratories and clinical departments, improving diagnostic accuracy, and ensuring evidence-based antimicrobial stewardship (AMS).

The mission and goals of the ASPIRE Consortium are:

1. To increase and sustain AMR surveillance at 4 large tertiary health facilities in Ethiopia and Ghana.

2. To establish eHealth development by implementing a DHIS2 based AMR surveillance and reporting system, integrating linkage between clinics and microbiology services.

3. To assess and characterize the burden of healthcare-associated infections (HAI), and develop feasible, adapted and cost-effective intervention to support infection prevention control measures (IPC) targeting HAI reduction.

4. To establish therapeutic drug monitoring (TDM) for commonly prescribed antibiotic drugs in Africa, and to assess for pharmacokinetics-pharmacodynamic (PK-PD) relationship against cultural-derived minimal inhibitory concentrations (MIC) for isolated bacteria, obtaining PK-PD target (PDT) attainment for optimized antibiotic treatment dosing.

5. To support the development of predicted pharmacodynamic target attainment (PTA) based on circulating bacterial strains and antibiotic drug levels in the African context.

6. To enhance antibiotic stewardship (ABS) procedures by integration of PDT/PTA variables.