This proposal is designed to address several critical aspects of the problem of antimicrobial resistance in Georgia, with the ultimate goal of limiting the development of bacterial resistance in, and its spread from, this developing country. The proposal is based on a strong research component and involves close collaboration between Georgian researchers and investigators in the United States. More specifically, four major tasks will be jointly addressed:

1. A central laboratory-based surveillance will be undertaken in Georgia for three major nosocomial pathogens of particular public health concern (“strains of interest”), including enterococci (with an emphasis on E. faecalis and E. faecium), S. aureus, and P. aeruginosa.

2. Antibiotic-resistance patterns of the strains of interest will be determined using modern antimicrobial susceptibility-testing techniques (conventional and genetic-based), with appropriate quality control performed at the University of Maryland.

3. Molecular subtyping of the strains of interest will be performed by pulsed field gel electrophoresis (PFGE) and randomly amplified polymorphic DNA (RAPD) techniques, and internet-based data exchange capabilities will be established at the NCDC; in addition, a novel typing methodology based on the multilocus sequence typing (MLST) technique will be developed for enterococci, and the enterococcal strains isolated in Georgia and the United States will be comprehensively analyzed for the first time by this novel approach.

4. Educational materials (e.g., brochures and handouts) about the judicious use of antibiotics will be developed and distributed to all major hospitals and medical centers in Georgia.

As a result of these activities, several Georgian scientists previously engaged in research associated with biological warfare will be able to redirect their activities to address one of the most urgent Georgian and global public health concerns, and they will have an opportunity to integrate their talents into the international scientific community. In addition, the successful completion of the project will significantly improve antibiotic-resistance testing capabilities in Georgia and will provide rigorous data about multidrug-resistant bacteria in the country – which will be critical for designing proper control and implementation strategies to prevent the spread of antibiotic-resistant bacteria in Georgia and to other countries from Georgia.

Furthermore, a new typing methodology for characterizing enterococci will be developed based on the MLST approach, which will provide a means for:

From a basic science standpoint, data generated during the project will: