Along with climate change and nuclear weapons, the key existential threats to humanity are pandemic infections and antibiotic resistance.
Moreover, infections are among the most common causes of hospital admission, and affect all of us during our lifetimes. Despite this, there is currently a lack of high-quality clinical evidence to guide the prevention and treatment of most infectious diseases. Our Infection Research Program covers three integrated themes:
Much of our work uses randomised clinical trials, the gold standard method to compare treatments or strategies for disease prevention or treatment.
Our HMRI Infection Research Program works to reduce the impact of infectious diseases on human health by addressing important evidence gaps in the diagnosis, prevention, and management of infections.
Over 120,000 hip or knee replacements are done annually in Australia and about 3,900 new prosthetic joint infections (PJI) are diagnosed in Australia each year.
PJIs are difficult to treat, expensive, and negatively impact patient’s quality of life. Current guidelines to treat PJIs are lacking evidence-based approaches.
The ROADMAP trial (RandOmised Arthroplasty infection worlDwide Multidomain Adaptive Platform trial) will compare the most common strategies in managing prosthetic joint infections and the optimal surgical strategies, and results will be directly translated into clinical guidelines and practice.
Our vision is to improve the treatment success of prosthetic joint infections, to improve patient-reported joint function and quality of life, and to reduce PJI related direct health care costs.
Bacteremia is the presence of bacteria in the blood stream. Bacteria may enter the circulation through medical procedures, certain tissue infections or even in everyday life through vigorous toothbrushing or minor cuts in the skin.
Most of the time, this is harmless. But if our immune system fails to defeat the bacteria, they can proliferate, spread to other organs and tissues, and cause severe infection and sepsis. We then depend on antibiotics to fight the bacteria.
Staphylococcus aureus is one of the most dangerous bacteria causing blood stream infection. Some of them have become resistant to certain antibiotics, and we need to find the medication that works best.
The SNAP Trial (Staphylococcus aureus Network Adaptive Platform trial) is comparing the effect of different antibiotics on bloodstream infections caused by Staphylococcus aureus to find the best treatment and to save lives.
The SNAP trial is co-led by Prof Josh Davis, and is a collaboration with the Doherty Institute at the University of Melbourne, along with over 70 hospitals across Australia, New Zealand, Singapore, Canada, Israel and the United Kingdom.
Antimicrobial resistance is an increasing problem worldwide. According to the Centers for Disease Control and Prevention (CDC), nearly 5 million deaths in 2019 were associated with antimicrobial resistance.
In Australian hospitals, 165,000 infections are acquired each year.
Many of these infections are multi-drug resistant. In addition, people with recurring infections requiring treatment with antibiotics are at greater risk to develop antimicrobial resistance. The first step in reducing the spread of resistance is to diminish the need for antibiotics in the first place.
Our Infection Research Program are conducting several clinical trials (commencing in 2023) which are investigating how enhanced cleaning of hospital equipment, changes in clinical practice and the implementation of innovative equipment such as air purifiers will help to prevent and control the spread of infectious diseases.
The COVID-19 pandemic has highlighted the need for more effective surveillance and early warning systems to detect and identify respiratory viruses that could be a threat to our community.
PREVENT is a pilot study nested within the 'Flutracking Project' and will monitor which respiratory viruses circulate across the Newcastle area over a seasonal cycle.
It will help to better understand the spread of common and novel respiratory viruses and has the potential to identify problematic viruses prior to turning into a threat. We further want to know if SARS-COV-2 replaced other coronaviruses or if those are still circulating.
Globally, there have been 615 million* confirmed cases of COVID-19 reported to the WHO and over 6.5 million people have died worldwide resulting from SARS-COV-2.
Although prevention through vaccination and public health measures remains the most important control mechanism, many vulnerable people still end up with COVID-19 which is severe enough to require hospital admission.
While severe medications have now been shown to improve outcomes in this setting, many questions remain, and it is unclear which of the currently available treatment strategies are most effective.
The AustralaSian COvid-19 Trial (ASCOT) investigates the effect of potential medication in COVID-19. This medication may also be effective in other viruses that can cause acute respiratory infections. This may help us to be better prepared for new respiratory viruses in the future. The ASCOT trial is co-led by Prof Josh Davis, and is a collaboration with the Doherty Institute at the University of Melbourne, along with hospitals across Australia, New Zealand, India and Nepal.
* as of 27th September 2022
Professor Brett Mitchell’s research was instrumental in evaluating and assisting the development of a portable isolation room (RediRoom), which can be used in clinical practice to protect patients and healthcare workers from acquiring infection.
In 2017, Professor Mitchell worked with a start-up company in Brisbane to help evaluate the product and subsequently introduced this company to GAMA Healthcare.
Fast forward to 2020 and The RediRoom is now available as a commercial product in Australia and overseas.
At the height of the COVID-19 pandemic in the UK, this room was deployed every 40 minutes in the NHS to protect patients and healthcare workers from acquiring COVID-19. The RediRoom has also attracted considerable positive media attention. Recently, Professor Mitchell, with international colleagues, published modelling work that found the RediRoom to be cost-effective for health services.
"Golden Staph” (MRSA, or methicillin-resistant Staphylococcus aureus) blood stream infections are resistant to first line antibiotics and 20-30% of affected people die as a result.
Many lab studies were published over the past 20 years suggesting that the addition of an antibiotic from the penicillin family to the current standard treatment (vancomycin) was far more effective at killing golden Staph.
As a result, many doctors had started prescribing this combination therapy for golden staph bloodstream infections, however there was no strong evidence of its effectiveness or safety in humans.
Professor Josh Davis led the first randomised clinical trial to assess this strategy, the CAMERA2 trial.
Contrary to expectation, he found that combination antibiotic therapy was actually dangerous, leading to a four-fold increase in the risk of kidney damage, with no benefit on mortality. Hence, treatment guidelines now recommend against this practice, potentially saving many patients from kidney damage and potentially associated mortality.
Professor Davis now co-leads the SNAP trial, which is investigating other strategies to improve outcomes from golden Staph infections.
Congratulations, Dr Toby Mills and team on the successful application for the 2023 Infection Research Program Seed Grant, worth $12,000.
Dr Toby Mills, Prof Nathan Bartlett, and Dr Camille Esneau will be working on an arbovirus surveillance study in Newcastle and the Hunter to better understand known and emerging threats of Mosquito Borne Diseases.
Mosquito borne viruses pose an ongoing risk to human health in Australia, as evidenced by the recent spread of Japanese Encephalitis virus. Key to managing this risk is surveillance of circulating mosquito borne viruses and mosquito populations. This Infection Research Program Seed Project aims to establish a local platform for surveillance of mosquito populations.
By combining the existing mosquito trapping capacity of Dr Toby Mills (University of Newcastle) with the molecular analysis facilities available at HMRI (Prof Nathan Bartlett & Dr Camille Esneau), we will enable the close surveillance of circulating arboviruses in the Newcastle and Hunter region including the monitoring of uncommon arboviruses, and potential discovery of new viruses. Our approach will combine targeted qPCR assays of routinely surveyed arboviruses (Ross River virus, Japanese Encephalitis virus, Bamah Forest virus and Murry Valley encephalitis virus) along with development of pan-flavivirus and pan-alphavirus PCR assays. This project will help us to better understand what local mosquito populations are the most dangerous for the local community and inform the design of local interventions to protect
The Infection Research Program is pleased to announce the two successful applicants of our 2022 Seed Grants, each worth $23,500. Congratulations, Dr Hemalatha Varadhan and Dr Matthew Rowlandson!
Hemalatha and team will be working on a molecular approach in diagnosing prosthetic joint infections: Hip and knee replacements are the two most common forms of joint replacement surgery. In Australia, the yearly rates of these surgeries have nearly doubled since 2005. Infections following joint replacement surgery affect about 1.7% of patients each year, causing loss of quality of life and severe physiological distress. Microbial cultures may not detect bacteria 10-15% of the time. Improved diagnostic tools are required to identify pathogens causing the infection and to rule out other causes of prosthetic joint failure.
“We aim to improve patient outcomes by using pathogen genomics to diagnose prosthetic joint infections. Our research will investigate whether next-generation DNA sequencing can supplement microbial culture in diagnosing prosthetic joint infections. We will compare two commercially available DNA sequencing technologies and assess their strengths and weaknesses, including accuracy of results, method complexity, and sequencing speed.
Ultimately, our goal is to design a pathogen genomics-based workflow for diagnosing prosthetic joint infections that could be implemented within the Clinical Microbiology Laboratory at John Hunter Hospital.”
Matthew and Katie will investigate immune response biomarkers in kidney transplant recipients:
“Kidney transplantation is the preferred treatment for patients with End Stage Kidney Disease. Despite the improvements in immunosuppressive strategies, infection-related complications remain a significant burden for kidney transplant recipients. Our study will explore our local cohort. We will be collating clinical and biochemical data and utilising novel biomarkers to investigate recipients’ immune response profiles.
Our overall aim is to establish an integrated biomarker-based and clinical infection risk assessment in kidney transplant patients to guide immunosuppressive altercating strategies before, during and after times of infection.”