The Study

The GRACE study aims to investigate the carriage and transfer of resistant bacteria or 'superbugs' in residential aged care.
“Place copy here from Geraint that summarises the study and the importance of its impact in the community.”
Professor Geraint Rogers — Study Lead


Resistant Bacteria

Antibiotics are our first line of defence against bacterial infections. Like all living things, bacteria evolve to survive. Some bacteria have evolved to resist antibiotics. Antibiotic resistant bacteria, or “superbugs” as they are sometimes known, pose one of the biggest threats to human health worldwide. If the rise and spread of superbugs continue at the current rate, common infections will become untreatable and medical procedures, such as minor surgery, will be unsafe. Experts believe that improving antibiotic prescribing practices and infection prevention and control techniques are critical in reducing the rise and spread of resistant bacteria, but more evidence is needed to best target efforts and resources in different settings.

Residential Aged Care

Residential aged care plays an essential role in caring for older Australians. Aged care facilities support the health care, lifestyle and accommodation needs of older people who are unable to continue living independently in their own homes. While antibiotic resistant bacteria can be found everywhere, they are a concern within residential aged care facilities. Frailty and reduced immunity experienced by older people, coupled with high rates of antibiotic treatment and the potential for transfer between residents, are thought to all contribute to resistant bacteria.

Why is the GRACE study needed?

The Generating evidence on Resistant bacteria in the Aged Care Environment (GRACE) study, aims to investigate the carriage and transfer of resistant bacteria or “superbugs” in residential aged care. The study is led by Professor Geraint Rogers from the South Australian Health and Medical Research Institute. Working in partnership with aged care providers the GRACE study will, for the first time, map the existence and spread of resistant bacteria in aged care. Funded by the National Health & Medical Research Council’s Medical Research Future Fund, this study will produce new evidence to help us to improve facility management, including cleaning and hygiene practices, to prevent the spread of harmful bacteria, and ultimately improve the health of aged care residents and the wider community. The GRACE study has been approved by the Southern Adelaide Clinical Human Research Ethics Committee.

  • Ageing Population
    By 2031, 21% of Australians will be aged over 65 years. Of these, 6% are expected to live in residential aged care, rising to 30% for individuals over 85 years.
  • Vulnerable to Infections
    Aged care residents are susceptible to infections for a variety of reasons including a weaker immune system, residing in a close living environment and hospitalisations.
  • Over use of Antibiotics
    In 2017 the Aged Care National Antimicrobial Prescribing Survey reported that more than half of antibiotic prescriptions were for residents with no signs and/or symptoms of infection.
  • Evidence of Superbugs
    Infections caused by resistant bacteria in residents of aged care homes is on the rise both in Australia and internationally.


The GRACE study will answer four important questions:

  1. What types of resistant bacteria are common within aged care facilities?
  2. How are resistant bacteria spread within aged care facilities?
  3. Do hospital visits influence the risk of carrying resistant bacteria?
  4. Do ageing-associated changes in gut health influence the risks from resistant bacteria?


In partnership with Eldercare, Life Care, Resthaven and Helping Hand the study will take place across several aged care facilities in South Australia. All people living in these facilities will be invited to participate in the study. People who consent to participate in the GRACE study will be asked for a throat swab and a sample of their stool. This is so we can identify potentially harmful and resistant bacteria that might be harboured in the throat or the gut. The study will also collect information about participants’ medical history and healthcare needs. We will also take environmental swabs from participants’ rooms and common areas around the facility. The purpose of this is so we can identify potential sources and transmission routes of resistant bacteria.

Data Analysis

Analysis of bacterial DNA from all samples collected will be carried out at the SAHMRI Microbiome laboratory at Flinders Medical Centre. Using a new method called metagenomic sequencing, we will be able to determine all bacteria that are present and whether they carry resistance genes. This is a novel approach to investigating resistant bacteria in an aged-care setting, which, combined with participant and environmental data, will allow us to better understand potential causes, sources and transmission routes of resistance.


We'd Love to Hear From You

The GRACE study achieved some fantastic findings, we'd love to share them with you.