R-Net SHIELD: Surveillance of healthcare data to identify and evaluate risk factors for predicting long-term colonization and infection with MDRO
The previous R-Net projects (R-Net 1.0 and 2.0) provided important insights into the prevalence of multidrug-resistant organisms (MDROs) through cross-sectional studies. However, the longitudinal development of colonization and the factors influencing its acquisition, persistence, and transmission remain poorly understood. The third project phase, R-Net SHIELD, addresses this knowledge gap by investigating colonization trajectories over an extended period. The project focuses on the dynamics of MDRO colonization and on identifying key factors that influence these processes across the continuum of care, particularly at the interface between inpatient and outpatient settings. Through repeated data collection and microbiological sampling, individual colonization trajectories are documented to improve understanding of the risk factors associated with long-term colonization and subsequent infections, ultimately enabling more accurate prediction of these outcomes.
Multidrug-resistant organisms (MDROs) continue to pose a significant challenge for healthcare systems. Persistent colonization not only facilitates transmission but also increases the risk of severe infections, particularly in hospital settings with vulnerable patient populations. However, most current surveillance approaches rely on cross-sectional data and fail to capture how colonization develops over time, how long it persists, and how the associated risk of infection changes.
R-Net SHIELD addresses this gap by extending the established R-Net platform into a longitudinal cohort study. Patients are followed for up to 12 months after hospital discharge, with repeated sampling and the structured collection of clinical and epidemiological data. This approach enables a detailed analysis of MDRO acquisition, persistence, and infection risk.
Within the project, microbiological, genomic, and clinical data from six university hospitals in Germany are integrated. In addition to the established target pathogens included in MDRO surveillance, the spectrum of pathogens is expanded to include emerging threats such as Candida auris and linezolid-resistant enterococci. Advanced methods such as whole-genome sequencing and the analysis of cell-free microbial DNA, provide detailed insights into the development of antimicrobial resistance, transmission pathways, and colonization dynamics.
A particular focus is on investigating heteroresistance—a form of hidden resistance that is often difficult to detect using standard diagnostic methods. The aim is to identify markers associated with an increased risk of treatment failure. At the same time, a digital, browser-based platform supports data collection, patient follow-up, and decentralized sampling both inside and outside the hospital.
By combining longitudinal data with translational research, R-Net SHIELD is establishing a unique cohort platform. This infrastructure will enhance our understanding of antimicrobial resistance and serve as a foundation for future interventional studies, as well as for the development of targeted prevention and treatment strategies.
