CRE-MARC (Centre for Research Excellence in Minimising Antibiotic Resistance in the Community) is an NHMRC-funded Centre for Research which started in Nov 2018 (for 5 years), at $2.5m

It builds on CREMARA (The Centre for Research Excellence in Minimising Antibiotic Resistance for Acute Respiratory Infections) which was funded by the NHMRC in 2012. This second CRE that is building on the achievements of CREMARA in acute respiratory infections and extends this research into a second phase of implementation and new work in urine and skin infections.

What CREMARA achieved: The team achieved 91 publications (a combination of articles that provided new knowledge, along with articles that emphasised research translation and practice and policy implications). Many of these articles generated knowledge about effective interventions that general practitioners (GPs) can adopt to reduce their prescribing of antibiotics for acute respiratory infections (ARIs). Additional funding (such as via NHMRC project grants scheme) was obtained to conduct large projects, such as nation-wide cluster randomised trials in general practice. The CREMARA team held two national summit meetings. The 2017 National Roundtable meeting involved presentations from and discussion with the United Kingdom’s Chief Medical Officer Dame Sally Davies, Australia’s Chief Medical Officer Prof Brendan Murphy, and key stakeholders from numerous federal and state government departments, agencies, and other research groups, and a report published in the MJA, and ongoing action planned developed.

The outputs from CREMARA have influenced policy in Government (eg Australian Strategic and Technical Advisory Group on Antimicrobial Resistance, ASTAG), Australian Commission on Safety and Quality in Health Care (ACSQHC); and professional bodies (eg Royal Australian College of GPs (RACGP) and other colleges). CREMARA has also strongly contributed to building research capacity, with 11 PhD scholars and post-doctoral research fellows, and >10 clinician-researchers developing skills in research and research translation in the important field of community antibiotic resistance research. One CREMARA post-doctoral research fellow has recently commenced an academic position in Denmark continuing to work in antibiotic resistance in the community and collaborate with our team.

What is needed next: CRE-MARC. Three major obstacles remain to reducing antibiotic use in Australian primary care:
1) the poor adoption of several effective interventions for improving ARI prescribing, which emphasises that the next steps should be implementation research focussed on improving uptake of these interventions into practice;
2) the need to broaden the focus beyond minimising antibiotic use in just acute respiratory infections (ARIs) and to include the two other major antibiotic indications in primary care – skin and soft-tissue infections (SSTIs) and urinary tract infections (UTIs); and
3) the well-known, but little understood, problem of very high use of antibiotics in Residential Aged Care Facilities (RACFs).