AMR.Solutions

Extending STEDI to diagnostics: STRIDES

Dear All (and with thanks to Betsy Trainor for co-authoring),

The idea of the STEDI values of an antibiotic (its fire extinguisher-like values) comes up often. As a reminder, the STEDI values are Spectrum, Transmission, Enablement, Diversity, and Insurance. As a good example, consider Enablement: knowing that an antibiotic exists as a backup makes safe (enables) therapies such as joint replacement because we can treat an infection should one arise. You can read about the application of STEDI in any of several places:


Overall, the point of STEDI is that antibiotics have value well beyond their (hopefully occasional) use to treat a specific infection in a specific person. 

So, what about diagnostics? These, too, have been struggling with their own economic challenges as evidenced by the slew of recent bankruptcy announcements (e.g., T2 Biosystems and Accelerate Diagnostics, BD spinning out their diagnostic unit). As the UK AMR Review clearly articulated in papers in 2015 (“Rapid diagnostics: Stopping unnecessary use of antibiotics”) and in 2016 (“Tackling drug-resistant infections globally: Final report and recommendations”), it makes intuitive sense that having a diagnosis would be helpful. But, the pragmatic challenge is that the relative ease of empirical therapy often wins out when contrasted at the caregiver level with the cost of the diagnostic (time and money) and its relative accuracy (no diagnostic is perfect). This is especially true in many LMICs where access to low cost generics is easy but access to diagnostic testing is limited.

The recently concluded VALUE-DX project was a big effort during 2019-2023 to address these linked issues in community-acquired respiratory tract infections. While the project consortium was frustrated by the COVID-19 pandemic, they did produce a range of perspective articles that are summarized on their publications webpage. As one example, consider “Improving antibiotic prescribing – Recommendations for funding and pricing policies to enhance use of point-of-care tests” by Vogler, Steigenberger, and Windisch in Health Policy OPEN. 2024;7:100129, https://doi.org/10.1016/j.hpopen.2024.100129.

With that brief history in mind, we turn today to the question of a STEDI-like perspective: Do diagnostics have values that go beyond their use on a specific sample from a specific person? If true, would recognizing such value help us dig out of the problem that empirical treatment is so VERY much easier on a busy clinic day than making a diagnosis?

Arguing “Yes, it is so!”, we have now a paper by Fong, Bray, Hampson, and Steuten entitled “Taking STRIDES: The Value of Diagnostics Against AMR.” These authors from the Office of Health Economics (OHE) propose STRIDES as an extension of STEDI.

To get us oriented to this idea, let’s start with their graphical summary of the diverse values inherent in diagnostic tools:

To start, note that there are two value elements at the top of the figure, to which STRIDES is a complement (not a substitute):

  • General value elements
    • Right drug to right patient
    • Reduced overall costs following from ensuring right drug to right patient
  • Diagnostic-specific value elements
    • Knowing the nature of the infection is powerful (bacterial vs. viral, etc.) independent of how that knowledge affects treatment


But, these two categories are both values that apply immediately to the diagnosed person. Thus, they are akin to the immediate value of giving an antibiotic to a specific patient. Yes, we’re diagnosing the type of fire (wood? electrical?) and then using the right type of fire extinguisher.

But, the point of STEDI is the hidden values of antibiotics … and so what are these for diagnostics? It gets very interesting here as you’re going to see STEDI + RS = STRIDES along with some reframing of the meaning of the STEDI elements. The builds on STEDI are marked below along with way(s) that STRIDES uses the STEDI elements in ways that are adjusted to the context of diagnostics:

  • Spectrum:
    • Diagnostics enable/support the use of narrow-spectrum antibiotics
    • And inversely, they could reduce use of broad-spectrum antibiotics
    • Indeed, diagnostics are the only way we can meet the STEDI goal of “Replacing broad spectrum agents with narrow spectrum agents and thereby reducing collateral damage to the microbiome”
  • Transmission
    • Timely identification of pathogens and resistance mechanisms would enable more rapid interventions
    • This includes both right drug to right patient as well as broader measures to slow or prevent outbreaks
    • This aligns precisely with the STEDI value of “Avoiding pathogen spread to the wider population by effectively treating patients”
  • Research (a build on STEDI): Pathogen-specific drugs can’t otherwise be developed!
  • Insurance
    • By knowing what drug is really needed, we can avoid over-prescribing and preserve last-line antibiotics. Think here of Neisseria gonorrhoeae where we are currently prescribing our last effective therapy as first-line therapy. Could diagnostics guide appropriate use of novel agents as they come to market (insurance) or will we likely wind up in this same situation again in the near future?
    • And further, having the right fire extinguisher for difficult pathogens means we can know when to use them to prevent large outbreaks
    • The STEDI value is “Having an agent available in case of a sudden or significant increase in the prevalence of pathogens resistant to existing agents (i.e. XDR Neisseria gonorrhoeae)” and you can see how the diagnostic allows us to choose the right therapy
  • Diversity
    • Personalized medicine! Knowing actual resistance for a given patient would permit use of the least antibiotic necessary for that infection, thus facilitating evidence-based variation in prescribing
    • Diversity in STEDI is defined as “Having a range of treatment options reduces selection pressure.” The diagnostic is the way we take advantage of that diversity
  • Enablement
    • A diagnostic could ensure we use the right prophylaxis agent for high-risk procedures (e.g., implant of an artificial joint)
    • This is a good build on the enablement idea in STEDI 
  • Surveillance (the other build on STEDI)
    • “Medicine is blind without diagnostics,” as Alain Merieux wisely says!
    • Further, understanding rising resistance rates empowers healthcare professionals to advocate for access to effective medicines now and in preparation for the future. 


As a further build on the conceptual STRIDES framework, the authors offer this visual to explain how the value(s) manifest over time:

Note in this figure that red text refers to (reasonably) real-time benefits whereas blue text refers to indirect (social) benefits. That’s an interesting separation but we’d maintain that ALL of the STRIDES benefits (red and blue) are still more akin to hidden benefits than to obvious, direct, general benefits. 

—
Well done by the team at OHE! Although STRIDES is not an answer to “what is the value?”, it does lay out a conceptual framework for ways to assess that value. This is exactly what STEDI did for antibiotics — you need to figure out how to talk about the problem before you can solve it. 

And, we note that the Team at OHE have also proposed a pathway for converting the conceptual framework to an actual value assessment in Brassel et al., “Capturing the Broader Value of Antibiotics: A Research Roadmap for STEDI” by https://www.ohe.org/publications/capturing-the-broader-value-of-antibiotics/.

Great stuff! We look forward to seeing this work evolve! All best wishes, John and Betsy

John H. Rex, MD | Chief Medical Officer, F2G Ltd. | Operating Partner, Advent Life Sciences. Follow me on Twitter: @JohnRex_NewAbx. See past newsletters and subscribe for the future: https://amr.solutions/blog/. All opinions are my own.

Betsy Wonderly Trainor, Alliance Director, CARB-X, [email protected]. These views are personal and do not necessarily reflect the views of CARB-X or any of its funders.

Current funding opportunities

  • The AMR Industry Alliance is again offering a Stewardship Prize of 10,000 CHF to recognize innovative approaches to combating AMR in low-to-moderate-income countries. This year’s prize focuses on utilizing diagnostics in stewardship efforts. Applications are due by 1 Sep 2025. Go here for details and to apply.
  • NNF (Novo Nordisk Foundation) have announced their “Challenge Programme 2026 – Unravelling the Pathways of Human Invasive Fungal Diseases. The call seeks applications from EU-centered consortia (global partners are possible) for research in 4 areas: (i) fungal virulence factors, (ii) host-pathogen interactions, (iii) mechanisms of anti-fungal resistance, and (iv) fungal disease markers. Applications are due by 8 Oct 2025. Go here for details. 
  • ENABLE-2 has continuously open calls for both its Hit-to-Lead program as well as its Hit Identification/Validation incubator. Applicants must be academics and non-profits in Europe due to restrictions from the funders. Applications are evaluated in cycles … see the website for details on current timing for reviews. 
  • CARB-X will have two calls during 2025 that span two areas: (i) Small molecules for Gram-negatives (the focus is on Pseudomonas aeruginosa) and (ii) Diagnostics for typhoid (the focus is diagnosis of acute infections in 60 minutes or less). See this 26 Feb 2025 newsletter for a discussion of the call and go here for the CARB-X webpage on the call. The first cycle is now closed (it ran16-30 April 2025); the 2nd round will be open 1-12 Dec 2025.
  • BARDA’s long-running BAA (Broad Agency Announcement) for medical countermeasures (MCMs) for chemical, biological, radiological, and nuclear (CBRN) threats, pandemic influenza, and emerging infectious diseases is now BAA-23-100-SOL-00004 and offers support for both antibacterial and antifungal agents (as well as antivirals, antitoxins, diagnostics, and more). Note especially these Areas of Interest: Area 3.1 (MDR Bacteria and Biothreat Pathogens), Area 3.2 (MDR Fungal Infections), and Area 7.2 (Antibiotic Resistance Diagnostics for Priority Bacterial Pathogens). Although prior BAAs used a rolling cycle of 4 deadlines/year, the updated BAA released 26 Sep 2023 has a 5-year application period that ends 25 Sep 2028 and is open to applicants regardless of location: BARDA seeks the best science from anywhere in the world! See also this newsletter for further comments on the BAA and its areas of interest.
  • HERA Invest was launched August 2023 with €100 million to support innovative EU-based SMEs in the early and late phases of clinical trials. Part of the InvestEU program supporting sustainable investment, innovation, and job creation in Europe, HERA Invest is open for application to companies developing medical countermeasures that address one of the following cross-border health threats: (i) Pathogens with pandemic or epidemic potential, (ii) Chemical, biological, radiological and nuclear (CBRN) threats originating from accidental or deliberate release, and (iii) Antimicrobial resistance (AMR). Non-dilutive venture loans covering up to 50% of investment costs are available. A closing date is not posted insofar as I can see — applications are accepted on a rolling basis; go here for more details.
  • The AMR Action Fund is open on an ongoing basis to proposals for funding of Phase 2 / Phase 3 antibacterial therapeutics. Per its charter, the fund prioritizes investment in treatments that address a pathogen prioritized by the WHO, the CDC and/or other public health entities that: (i) are novel (e.g., absence of known cross-resistance, novel targets, new chemical classes, or new mechanisms of action); and/or (ii) have significant differentiated clinical utility (e.g., differentiated innovation that provides clinical value versus standard of care to prescribers and patients, such as safety/tolerability, oral formulation, different spectrum of activity); and (iii) reduce patient mortality. It is also expected that such agents would have the potential to strongly address the likely requirements for delinked Pull incentives such as the UK (NHS England) subscription pilot and the PASTEUR Act in the US. Submit queries to [email protected].
  • INCATE (Incubator for Antibacterial Therapies in Europe) is an early-stage funding vehicle supporting innovation vs. drug-resistant bacterial infections. The fund provides advice, community, and non-dilutive funding (€10k in Stage I and up to €250k in Stage II) to support early-stage ventures in creating the evidence and building the team needed to get next-level funding. Details and contacts on their website (https://www.incate.net/).
  • These things aren’t sources of funds but would help you develop funding applications
    • The Global AMR R&D Hub’s dynamic dashboard (link) summarizes the global clinical development pipeline, incentives for AMR R&D, and investors/investments in AMR R&D.
    • Antimicrobial Resistance Research and Innovation in Australia is an actively updated summary that covers Australia’s AMR research and patent landscape. It is provided via collaboration between The Lens (an ambitious project seeking to discover, analyse, and map global innovation knowledge) and CSIRO (Commonwealth Scientific and Industrial Research Organisation, an Australian Government agency responsible for scientific research). Lots to explore here!
    • Diagnostic developers would find valuable guidance in this 6-part series on in vitro diagnostic (IVD) development. Sponsored by CARB-X, C-CAMP, and FIND, it pulls together real-life insights into a succinct set of tutorials.
  • In addition to the lists provided by the Global AMR R&D Hub, you might also be interested in my most current lists of R&D incentives (link) and priority pathogens (link).

John’s Top Recurring Meetings
Virtual meetings are easy to attend, but regular attendance at annual in-person events is the key to building your network and gaining deeper insight. My personal favorites for such in-person meetings are below. Of particular value for developers, the small meeting format of BEAM’s AMR Conference and GAMRIC (formerly, the ESCMID-ASM conference series) creates excellent global networking. IDWeek and ECCMID are much larger meetings but also provide opportunities for networking with a substantial but focused audience via their Pipeline sessions. Hope to see you there!

  • 1-3 Oct 2025 GAMRIC, the Global AMR Innovators Conference (London, UK). Formerly the ESCMID-ASM Joint Conference on Drug Development for AMR, this meeting series is now in its 10th year and is being continued under the joint sponsorship of CARB-X, ESCMID, BEAM Alliance, GARDP, LifeArc, Boston University, and AMR.Solutions. The ongoing series will continue the successful format of prior meetings with a single-track meeting and substantial networking time (go here to see details of the outstanding 2024 meeting).
    • Registration is now open and the preliminary agenda can be found at that same link (https://www.gamric.org/). The meeting will be limited to approximately 300 attendees, so please be sure to register promptly to avoid disappointment! 
    • The abstract submission window (same link as registration) runs until 13 June.
    • Application for travel grants (same link as registration) are accepted through 2 June.
  • [Note call for IDWeek 2025 Pipeline presentations] 19-22 Oct 2025 (Georgia, USA): IDWeek 2025, the annual meeting of the Infectious Diseases Society of America. Go here to register. For those who would like a substantial opportunity to present a product (see also ECCMID), note the call for applications to present at an IDWeek Pipeline Session; go here to submit an application for your compound or diagnostic.
  • 3-4 Mar 2026 (Basel, Switzerland): The 10th AMR Conference. Sponsored by the BEAM Alliance, the 9th AMR Conference has just concluded and it’s again been an excellent meeting! Please mark your calendar for next year. You can’t register yet, but details will appear here! 
  • [Note that ESCMID’s Pipeline Monday will again occur in 2026] 17-21 April 2026 (Munich, Germany): ESCMID Global 2026, the annual meeting of the European Society for Clinical Microbiology and Infectious Diseases. You can’t register yet, but you can go here for details on the outstanding 2025 meeting. For those who would like a substantial opportunity to present a product (see also IDWeek), I also know that the meeting schedule will again include Pipeline Monday; go here to see details from 2025.

  Upcoming meetings of interest to the AMR community:

  • 19-23 June 2025 (Los Angeles): ASM Microbe, the annual meeting of the American Society for Microbiology. Go here for details.
  • 10-11 Sep 2025 (Ghent, BE): Organized by a group at Ghent University in collaboration with the ESCMID Study Group for Non-Traditional Antibacterial Therapy (ESGNTA), the Phage Protein Meeting is an interdisciplinary conference dedicated to advancing the field of phage proteins for infection control that seeks to bring together academic researchers and professionals working with phage proteins such as phage lysins, tail fibers, tailspikes, depolymerases, and tailocins. Note that the focus here is on phage proteins rather than phage themselves. Go here for details and to register.
  • 12 Sep 2025 (Ghent, BE): The 10-11 Sep 2025 meeting just above is followed in Ghent on 12 Sep by the 4th annual meeting of BSVoM (Belgian Society for Viruses of Microbes). This meeting is broader than therapeutics, providing an “interdisciplinary perspective on virus of microbes, ranging from basic research to industrial developments and clinical use.” Go here for details.
  • 10-13 Sep 2025 (Lisbon, Portugal): 6th ESCMID Conference on Vaccines. Go here for details.
  • 1-3 Oct 2025 GAMRIC, the Global AMR Innovators Conference (London, UK; formerly the ESCMID-ASM Joint Conference on Drug Development for AMR). See list of Top Recurring meetings, above..
  • 11-19 Oct 2025 (Annecy, France, residential in-person program): ICARe (Interdisciplinary Course on Antibiotics and Resistance) … and 2025 will be the 9th year for this program. Patrice Courvalin orchestrates content with the support of an all-star scientific committee and faculty. The resulting soup-to-nuts training covers all aspects of antimicrobials, is very intense, and routinely gets rave reviews! Seating is limited, so mark your calendars now if you are interested. Applications are being accepted from 20 Mar to 21 Jun 2025 — go here for more details.
  • 17-20 Sep 2025 (Porto, PT): 14th International Meeting on Microbial Epidemiological Markers (IMMEM XIV). Go here for details.
  • 9-13 Nov 2025 (Portland, OR, USA): ASM Conference on Biofilms. Go here for details and to register.
  • 18-24 Nov 2025 (global, multiple locations): World Antibiotic Awareness Week (WAAW) is convened annually on 18-24 Nov by WHO with national events (e.g., CDC’s US Antibiotic Awareness Week (USAAW); ECDC’s 18 Nov European Antibiotic Awareness Day) occurring around the globe. Details will follow as events become visible.
  • 19-22 Oct 2025 (Georgia, USA): IDWeek 2025. See list of Top Recurring meetings, above.
  • 29-31 Oct 2025 (Bengalaru, India): ASM Global Research Symposium on the One Health Approach to Antimicrobial Resistance (AMR), hosted in partnership with the Centre for Infectious Disease Research (CIDR) at the Indian Institute of Science (IISc). Go here for details and to register.
  • 28-30 Jan 2026 (Las Vegas, NV, USA): IDSA and ASM have announced a new US-based meeting series entitled IAMRI (Interdisciplinary Meeting on Antimicrobial Resistance and Innovation) and described as a “forum for collaboration and exploration around the latest advances in antimicrobial drug discovery and development.” You can’t register yet (further details anticipated June 2025) but you can go here to see general details about the new meeting.
  • 3-4 Mar 2026 (Basel, Switzerland): The 10th AMR Conference sponsored by the BEAM Alliance. See list of Top Recurring meetings, above.
  • 8-13 Mar 2026 (Renaissance Tuscany Il Ciocco, Italy): 2026 Gordon Research Conference (GRC) entitled “Antibacterials of Tomorrow to Combat the Global Threat of Antimicrobial Resistance.” A Gordon Research Seminar (GRS) will be held the weekend before (7-8 Mar) for young doctoral and post-doctoral researchers. Space for the GRS and the GRC is limited; for details and to apply, go here for the GRC and here for the GRS.
  • 17-21 April 2026 (Munich, Germany): ESCMID Global 2026, the annual meeting of the European Society for Clinical Microbiology and Infectious Diseases. See Recurring Meetings list, above.

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