Antibiotic resistant disease is one of world’s biggest public health issues. According to the US based Centers for Disease Control and Prevention, at least 2.8 million Americans get an antibiotic-resistant infection each year, of which more than 35,000 die. Globally, antibiotic resistance causes at least 700,000 deaths.
Much of the blame for antibiotic resistance is due to the overuse of antibiotics in treating illness, such as MRSA – methicillin-resistant staphylococcus aureus, a bacterium that is resistant to several antibiotics, including methicillin. Unfortunately, Australia is one of the world’s highest users of antibiotics.
In Australia, antibiotic-resistant infections are particularly prevalent in Indigenous communities in northern Australia. The rate of MRSA in remote and very remote areas of Northern Australia is double that of major cities. The prevalence of MRSA in northern Australia means Indigenous people can no longer simply rely on first line antibiotics for treatment.
It was this challenge that Professor Emma McBryde from the Australian Institute for Tropical Health and Medicine (AITHM) at James Cook University Townsville set out to find a solution to.
One of Australia’s most renowned infectious disease modellers, Professor McBryde received a $300,000 Advance Queensland Research Fellowship in 2017 to support her research on using a system approach to antibiotic resistant infections.
She set out to develop an evidence-base to improve treatment for patients presenting to hospital, using a combination of mathematics, IT and medicine.
As part of her fellowship, Professor McBryde worked closely with Townsville Hospital, using the hospital’s database to follow over 40,000 patients with an infectious disease diagnosis over 11 years.
Professor McBryde and her team developed a complex database of their own, linking hospital administrative data with clinical data as well as additional data outside of the hospital, including death registry and notifiable infectious diseases data, out of which they developed algorithms that feed into more efficient and better suited clinical decision-making.
We caught up recently with Professor McBryde in regard to her research project. We also spoke about her background, in particular what drew her to mathematics in solving some of our biggest medical challenges.
Professor McBryde grew up in Kenmore. Her family comes from Maryborough.
She did her medical training at the University of Queensland and her clinical training at Brisbane’s Princess Alexandra Hospital and the Royal Melbourne Hospital plus one year at the Mater Hospital, also in Brisbane.
She is currently the Professor of Infectious Diseases Epidemiology at the AITHM.
How does your research assist the hospital assess risk factors for death and prolonged stay?
When we find risk factors for poor outcomes, including length of stay, ICU admissions and death, we can provide algorithms for risk stratification. Examples of this already in action are the community acquired pneumonia scores often deployed in emergency departments. These have been developed for Western Health settings and may understate risk for Indigenous people, the main factor being age cut-off. Risk in Indigenous people increases years earlier than risk for non-Indigenous Australians. Thus algorithms can be adapted to ensure the best response.
You’re looking at a care regime that decreases the use of antibiotics – why?
It is crucial to use only as much antibiotic as necessary because overuse leads to poor clinical outcomes (severe diarrhea, unnecessary reactions) and also to increasing resistance at a community level.
Could this model be applied to other hospitals? How?
Yes, and it is being applied. Now that we have electronic medical records, there is expanded option for real time analysis too. We have requested an extension of this project to include all five of the Tropical Australian Academic Health Centre hospitals: Cairns and Hinterland Hospital and Health Service, Mackay Hospital and Health Service, North West Hospital and Health Service, Torres and Cape Hospital and Health Service, and Townsville Hospital and Health Service.
Why is it important to identify patients at high risk of harbouring a contagious infectious disease on admission? How does your system come into play here?
Some highly antibiotic resistant bacteria are sought on admission and people who are infected or even just colonised with them need to be isolated from other people. Who is isolated may vary from time to time and place to place depending on how rare the pathogen is. We are often looking for factors that can alert us to the possibility of contagious infections, so that we test and therefore avoid transmission within the hospital. It is also crucial for the patient to get early antibiotics right. For severe sepsis, missing the antibiotic resistance and giving the wrong antibiotic in the early hours of presentation increases risk of death.
You found that Indigenous people had higher admission rates for lower tract infections and also stayed in hospital on average 2.5 days longer – once again, how does this knowledge help improve patient care?
Anticipating a stormier course allows for action plans to be put in place early. Also some of the delay returning to the community may reflect remote location of these patients and a bottleneck in getting them home in a timely manner – which has been fed back to the hospital administration.
You found that even in North Queensland, cooler winter weather resulted in more people presenting to hospital with flu and pneumonia. You’ve developed a predictive algorithm to help hospitals cater for this – how does that work?
We have shown that weather events predict excess of influenza and pneumonia even in the tropics. We did this by using a statistical model to examine hospitalisations alongside weather events over many years to look for consistent patterns
This can help with workforce planning. We need to ensure that we avoid the situation in which “winter comes as a surprise” every year!
Why did you decide to continue study in infectious diseases and then mathematics rather than follow a career as a GP?
I have always been interested in big global health problems and how they impact on society. This led to the selection of infectious diseases as my specialty. Also I have always been interested in mathematics, so I found a way to combine my two interests. I did my PhD at QUT in a Mathematics/Statistics Department.
What would you say is your biggest driver?
I enjoy thinking through big problems, particularly with small groups of people with complementary skills to create something none of us could do alone. Working in infectious diseases ensures this work is also potentially of value to people across the globe.
When did you join the AITHM?
I joined in 2015, after working at the Victorian Infectious Diseases Service, Doherty Institute from 2007 until 2015.
What attracted you to come back to Queensland? And why the AITHM and why Townsville?
The AITHM has a clearly articulated vision to serve the health of the tropics starting with North Queensland and reaching out to the whole of the tropical region. This fits in very well with my interests in tuberculosis and emerging infectious diseases
Why the interest in TB?
TB is the biggest infectious diseases killer globally (still just ahead of COVID-19 for 2020). It is a fascinating infection clinically, historically and from a societal and public health perspective.
How important is the application of mathematics to fighting infectious disease?
I hope it has an important and increasingly relevant and recognised role. It allows ideas to be tested out “in silico” before they are implemented in public health or in randomised controlled trials. It also provides insights into epidemiology that are not immediately obvious. One example of this is that TB elimination in some countries will not be possible even with strenuous efforts to reduce transmission, because of the large number of “latently infected” people who will get active disease in the future resulting from infection already acquired.
What gives you the greatest job satisfaction?
Four things: teaching, learning, collaborating in small groups, and challenging the dominant paradigm
What is your favourite TV show, movie?
Favourite recent TV series without a doubt is Fleabag and Fleabag 2. For serious movies, I like historical fiction or biographies. I recently watched The Spy and Hannah Arendt, which were both brilliant. For tuning out, I will watch just about anything, the schmaltzier the better as long as it offers something original. For example, I like old musicals like The Rocky Horror Picture Show, The Sound of Music and Grease.
Who is your hero?
I like self-deprecating and transgressive people, particularly comedians who challenge orthodoxy; so the list is fairly long here. I would say Ricky Gervais, Phoebe Waller- Bridge (from Fleabag), and US comedian Bill Maher. For scientific heroes of course it is Einstein – I am not too original there. But the thing about him is not so much that he was smart (which undoubtedly he was), but that he was willing to throw out everything we consider true and natural and remake the model of the universe in a new way. It fits the data better, it was in fact what the data was telling us, but it made no sense to others. He was ridiculed but held firm. I love that.