The Antibacterial Resistance Leadership Group: Scientific Advancements and Future Directions
Authors: Chambers Henry F , Cross Heather R , Souli Maria , Evans Scott R , Patel Robin , Fowler Vance G ,   for the Antibacterial Resistance Leadership Group, Lodise Thomas , Deckard Nancie , Schuler Carl , Bunn Ivra , Holland Thomas , Turner Nicholas , Zaharoff Smitha , Sharma Shrabani , Wickward Cathy , Waller Jason , Wilson Holly , van Duin David , Baum Keri , Komarow Lauren , Wang Minggui , Evans Beth , Hopkins Deborah , Ge Lizhao , Giri Abhigya , Dai Weixiao , Diao Guoqing , Fidler Tamara , Shao Wanying , Schwager Nyssa , Bonomo Robert , Mau Donald , Satlin Michael , Li Yixuan , Tamma Pranita , Schooley Robert , Hamasaki Toshimitsu , Sund Zoe , Booth Grant , Estes Leslie , Greenwood-Quaintance Kerryl , Parmar Krupa Mukesh , Cunningham Scott , Doernberg Sarah , Dodd Andrew , Tsalik Ephraim , Tillekeratne Gayani , Raza Praneeta , Zeng Lijuan , Banerjee Ritu , Abbenante Erin , Mocka Elizabeth , King Heather , Kinamon Tori , Howard-Anderson Jessica , Boucher Helen , Geres Holly , He Yijie , Mehigan Maureen , Ghazaryan Varduhi , Nayak Seema , Raterman Erica , Samuel Tamika , Lee Marina 
Published: October 2023

In this overview, we describe important contributions from the Antibacterial Resistance Leadership Group (ARLG) to patient care, clinical trials design, and mentorship while outlining future priorities. The ARLG research agenda is focused on 3 key areas: gram-positive infections, gram-negative infections, and diagnostics. The ARLG has developed an innovative approach to clinical trials design, the desirability of outcome ranking (DOOR), which uses an ordinal measure of global outcome to assess both benefits and harms. DOOR was initially applied to observational studies to determine optimal dosing of vancomycin for methicillin-resistant Staphylcococcus aureus bacteremia and the efficacy of ceftazidime-avibactam versus colistin for the treatment of carbapenem-resistant Enterobacterales infection. DOOR is being successfully applied to the analysis of interventional trials and, in collaboration with the US Food and Drug Administration (FDA), for use in registrational trials. In the area of diagnostics, the ARLG developed Master Protocol for Evaluating Multiple Infection Diagnostics (MASTERMIND), an innovative design that allows simultaneous testing of multiple diagnostic platforms in a single study. This approach will be used to compare molecular assays for the identification of fluoroquinolone-resistant Neisseria gonorrhoeae (MASTER GC) and to compare rapid diagnostic tests for bloodstream infections. The ARLG has initiated a first-in-kind randomized, double-blind, placebo-controlled trial in participants with cystic fibrosis who are chronically colonized with Pseudomonas aeruginosa to assess the pharmacokinetics and antimicrobial activity of bacteriophage therapy. Finally, an engaged and highly trained workforce is critical for continued and future success against antimicrobial drug resistance. Thus, the ARLG has developed a robust mentoring program targeted to each stage of research training to attract and retain investigators in the field of antimicrobial resistance research.