12 June 2020
In intensive care units around the world, critically ill patients – adults and children – have a greater chance of a good outcome, thanks to collaborative health research happening in Queensland. Brisbane Diamantina Health Partners (BDHP) exists to identify and support the translation of this impactful health research into practice as quickly as possible.
University of Queensland Professor and NHMRC Practitioner, Fellow Jason Roberts and his team, have just launched Therapeutic Drug Monitoring (TDM) Guidelines that give clear universal directions about how to optimise the use of antibiotics for critically ill patients. These international guidelines will improve the standard of care in intensive care units (ICUs) worldwide, speeding up recovery times, saving lives and generating significant cost savings for health systems globally.
Jason’s principal research interest stems from his experience as a newly-graduated pharmacist on rotation through the Royal Brisbane Women’s Hospital. He realised that an important area that would benefit ICU patients was through maximising the effectiveness of antibiotics by better dosing. He also considered this to be an area to target for improvement in clinician knowledge. The new guidelines are the culmination of years of collaborative research. The project was led from Brisbane and included professional input from 12 countries around the world. Now, clinicians in hospitals everywhere have a tried and tested framework to guide their treatment decisions. But this is far from the end of the journey for this research team.
In 2019, Jason’s project was one of six in Queensland to share $1.4M secured by BDHP under the Medical Research Future Fund’s (MRFF) Rapid Applied Research Translation initiative (RART). This was the second MRFF RART grant Jason’s team had received to progress this research. The first grant helped them to establish a baseline of data to use bacterial genomics to guide the selection of antibiotics.
With BDHP’s grant, Jason and his team are testing the use of advanced software to predict accurate drug doses and generate personalised treatment regimens. Rather than giving all critically ill patients the same dose as is common practice, the software can identify (based on input about the individual patient and the bacteria) the optimal medicine and dose for that patient. This approach has benefits for the individual and the wider community as it reduces the opportunity for antibiotic-resistant infections to develop and spread.
Jason made the research project as multidisciplinary and multisite as possible. The team will now test how well the dosing software works at the Royal Brisbane Women’s Hospital, the Prince Charles Hospital, the Princess Alexandra Hospital and the Queensland Children’s Hospital (QCH). If the testing continues to succeed, they could be using the dosing software as standard practice within six months. This preliminary work will also allow Jason to seek funding for a larger study and provide the final validation of the cost benefits for healthcare delivery.
Working in partnership with Jason on the software antibiotic dosing project, and leading the state-wide response to paediatric sepsis is UQ Associate Professor Luregn Schlapbach. A specialist at the QCH and researcher at the UQ Children’s Health Research Centre, Luregn’s research has focused on sepsis and life-threatening infections in children. In the past years, the team has progressed this research from studying the epidemiology of sepsis to understanding what’s happening at a genetic level.
Luregn recently received funding to expand this research under the Federal Government’s $500 million Genomics Health Futures Mission. Luregn said the latest funding is a direct result of seed funding secured through BDHP, which helped the team prove their concept and gather enough data to justify a larger research project that will ultimately lead to better diagnosis and care. Luregn’s research into sepsis has also received funding support from several foundations, including the Emergency Medicine Foundation, the Gold Coast Hospital, the Far North Queensland Foundation and the Children's Hospital Foundation.
Sepsis is a life-threatening illness caused by an abnormal response to an infection resulting in the shut-down of vital organs. Without quick treatment, sepsis can lead to severe illness, multiple organ failure and death. Every year, close to 20,000 Australians develop sepsis and more than 5,000 lose their lives to the illness. From early on in his training, Luregn became intrigued by why sepsis happened, and why it severely affected some children and not others.
Luregn and his team are expanding our understanding of this disease and how to improve its diagnosis in children through the use of genomic knowledge and technology. Their research has a strong discovery focus, with the team recruiting, over several years, hundreds of critically ill children with suspected sepsis in Queensland hospitals including at the QCH, the Gold Coast Hospital, the Townsville Hospital and on Thursday Island. Now, the team will expand its multi-site recruitment to other ICUs in Australia and build a cohort of 1,500 children.
As well as clinical partners, the research project has a strong laboratory network in immunology and gene expression, including the UQ Institute of Molecular Bioscience, the Translational Research Institute, the UQ Diamantina Institute and other UQ institutes. This gives the research team access to state-of-the-art infectious tests and world-class gene expression pipelines. The analysis is done in conjunction with Associate Professor Lachlan Coin, one of the leading researchers in the field of gene expression now based at the University of Melbourne. The team also actively contacts gene expression teams in the United States and Europe.
Proving that this research project has the potential to evolve into a point-of-care test, Luregn’s team is working closely with ImmunExpress, the first company to develop a commercial gene expression-based sepsis test. Originating from Brisbane, ImmunExpress uses gene expression signatures in our blood to detect a patient's immune response to a pathogen.
From Queensland, these two collaborative research projects address global health challenges and are expected to lead to robust findings that will revolutionise healthcare delivery for critically ill adults and children. The projects are expected to lead to robust findings, which, with further support, can be implemented to improve diagnosis, reduce the unnecessary use of antibiotics, leading to better patient outcomes and major cost savings for health systems around the world.
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