A Clinically Oriented Antimicrobial Resistance Surveillance Network for Healthcare-Associated Infections (ACORN-HAI)

A hospital patient with a bloodstream infection or ventilator-associated pneumonia is increasingly likely to be infected with a multidrug-resistant bacterium that no existing antibiotic can treat, and doctors lack the real-world data needed to decide what to do about it. This surveillance network, called ACORN-HAI, will track 500 patients at each of 30 hospitals across regions with high drug-resistance burdens, collecting detailed clinical data on treatment and outcomes. The problem is that prospective, case-level data on these severe healthcare-associated infections barely exist. Without it, researchers cannot design reliable interventional trials to test new treatments or optimise existing ones. The network will also collect bacterial isolates for genomic analysis, revealing how resistance genes and clones spread across geography and time. If successful, ACORN-HAI will produce the first large-scale, standardised picture of how these infections are treated and what happens to patients. That evidence base will directly inform the design of future clinical trials, giving them realistic endpoints and target populations. For hospital clinicians, the results could eventually mean knowing which antibiotics still work for a given infection, rather than guessing. For the broader public, the network builds laboratory and research capacity in the very settings where drug resistance is most acute, creating infrastructure that outlasts any single study.