ECRAID-Base (European Clinical Research Alliance for Infectious Diseases) continues the activities of PREPARE, COMBACTE and ECRAID-Plan, which will lead to establishing ECRAID as an independent non-for-profit legal entity in December 2020. ECRAID-Base is the initial set of activities for ECRAID. As a European clinical research network ECRAID-Base will generate rigorous evidence to improve diagnosis, prevention and treatment of infections and to better respond to EID threats.. The network has already been successfully used during the COVID-19 pandemic, with valuable lessons learned. At the heart of ECRAID-Base are 6 perpetual studies; 5 observational studies in ICU (WP2), ER (WP3,4&5) and primary care (WP6), addressing infections relevant for AMR (VAP in WP2 & cUTI in WP3) and EID (ARI in WP4 & WP6, and Disease X in WP5). All will mature towards adaptive platform trials, with capability to rapidly respond to public health threats. These 5 studies will enroll around 20,000 patients per year. The sixth perpetual study is the Randomized Embedded Multifactorial Adaptive Platform (REMAP) for patients with severe CAP in ICU, with capability of rapid adaptation to new public health threats as demonstrated. In a response to COVID-19 the platform was (within 2 months) adapted with new COVID-19 treatment domains and enrolment of non-ICU patients, and the number active sites rapidly increased in 213 sites (June 4th) with 1084 patients enrolled (567 with COVID-19). Supportive to the clinical studies are work packages LAB (for laboratory support), DATA (for datamanagement and innovative epidemiological and statistical research), TRAIN (for training) and PREP (for improving responsiveness to new public health threats). ECRAID-Base, therefore, establishes a pan-European clinical research network to increase efficiency for testing and developing new diagnostic, preventive and/or therapeutic strategies and therapies and improving responsiveness to new public health thretbd

Antimicrobial resistance (AMR) is of great public health concern, causing numerous losses of lives worldwide and threatening to reverse many of the considerable strides modern medicine has made over the last century. There is a need to stratify antibiotic and alternative treatments in terms of the actual benefit for the patient, improving patient outcome and limit the impact on AMR. High quality, effective and appropriate diagnostic tests to steer appropriate use of antibiotics are available. However, implementation of these tests into daily healthcare practice is hampered due to lack of insight in the medical, technological and health economical value and limited knowledge about psychosocial, ethical, regulatory and organisational barriers to their implementation into clinical practice. VALUE-Dx will define and understand these value indicators and barriers to adoption of diagnostics of Community-Acquired Acute Respiratory Tract Infections (CA-ARTI) in order to develop and improve health economic models to generate insight in the whole value of diagnostics and develop policy and regulatory recommendations. In addition, efficient clinical algorithms and user requirement specifications of tests will be developed fuelling the medical and technological value of CA-ARTI diagnostics. The value of diagnostics will be tested and demonstrated in a unique pan-European clinical and laboratory research infrastructure allowing for innovative adaptive trial designs to evaluate novel CA-ARTI diagnostics. Close and continuous interaction with the VALUE-Dx multi-stakeholder platform provides for optimal alignment of VALUE-Dx activities with stakeholder opinions, expert knowledge and interests. A variety of dissemination and advocacy measures will promote wide-spread adoption of clinical and cost-effective innovative diagnostics to achieve more personalized, evidence-based antibiotic prescription in order to transform clinical practice, improve patient outcomes and combat AMR.