Queensland Paediatric Infectious Diseases (QPID) Research Group projects

Duration: January 2019 –

Funding Source: None

Chief Investigators: Adam Irwin, Sophie Wen, Lars Eriksson, Luregn Schlapbach, Julia Clarke, Anita Campbell, Asha C Bowen, Chris Blyth, Henry Chambers, David Paterson

HDR Student: Dr Sophie Wen

Aim

This research aims to define core outcome sets for future antimicrobial clinical trials in children with bloodstream infections, incorporating important patient reported outcome measures. 

Background

There are limited numbers of antimicrobial clinical trials conducted in children and there is significant variability in trial reporting, which reduces the comparability of findings and subsequent challenges for translation into clinical practice. Core outcome sets (COS) are an agreed standard set of outcomes that all clinical trials should, at a minimum, measure and report on for a specific area of health.

Key clinical challenges include:

• There are currently no uniform outcome measures defined for antimicrobial trials of bloodstream infections in children
• There is also often a lack of consumer involvement in the development of COS

Impact

In order for clinicians to confidently interpret the relevance of trial findings for their patients and setting, the selection and reporting of COS is crucial. Our research will define a COS for future antimicrobial clinical trials in children with bloodstream infections, incorporating important patient reported outcome measures.  A scoping review protocol is published online: https://osf.io/wchx8/

Duration: July 2020–June 2024

Funding source: Children’s Hospital Foundation

Chief Investigators: David Whiley, Emma Sweeney, Adam Irwin, Helen Farrell, Julia Clark, Chris Fraser, Amy Jennison, David Warrilow

Masters Student: Jocelyn Hume

Aim

To develop novel molecular diagnostic assays to rapidly detect active Cytomegalovirus infection and associated antiviral resistance in children receiving haematopoietic stem cell transplantation.

Background

Cytomegalovirus is a type of Herpesviridae that is ubiquitous around the world. In healthy individuals it causes a mild illness, however it has the ability to evade the immune system and become latent for life. In immunosuppressed individuals it can reactivate, causing serious disease and increasing the risk of mortality.

Key Clinical Challenges Include:

• With the current diagnostic tests [polymerase chain reaction] being extremely sensitive, subclinical cytomegalovirus can be detected, leading to overtreatment of patients.
• Overtreatment of cytomegalovirus can lead to mutations occurring, allowing for antiviral resistance to develop.
• Antiviral resistance testing can take considerable time to perform, days to weeks in some cases. During this time, clinicians have little to no information regarding which treatments will be effective.

Impact

The novel molecular diagnostic assays developed with this project will allow for the differentiation between active and latent cytomegalovirus infections and rapidly detect associated antiviral resistance. This will empower clinicians to know when to start/stop treatment and which treatments will be effective, greatly improving the outcomes for children receiving haematopoietic stem cell transplantation.

Duration: 2016 – 2022

Funding Source: Sexual Health Research Foundation/ASHM

Chief Investigators: Clare Nourse, Judith Dean, Mandy Wu, Mandy Seel, Sumi Britton, Li jun Theah,

Aim

To evaluate the management of syphilis in pregnant women and their infants to identify gaps in care to prevent CS. Additionally, we aim to perform qualitative interviews of health care workers and women to identify gaps in knowledge that contribute to gaps in management

Background

Infectious syphilis notifications are increasing in Australia with a well-documented outbreak in remote and regional areas.

Key Clinical Challenges Include:

• In Queensland, 66% of notifications in 2019 were from South-East Queensland (SEQ), mainly among non-Indigenous people.
• There has been a concomitant rise in syphilis in pregnancy and congenital syphilis (CS) due to vertical transmission.
• Appropriate management of syphilis in pregnancy includes antenatal screening, contact tracing and management, penicillin treatment >30 days before delivery and serological follow-up to ensure adequate treatment and exclude re-infection.
• If management is ineffective, mother-to-child-transmission leads to acute and chronic sequelae e.g CS, preterm and low birth weight deliveries, miscarriage, stillbirth and ­­neonatal death.

Impact

Recommendations have been made to improve management of syphilis in pregnancy

Ongoing research to identify gaps in knowledge of HCW and patients.

Duration: 2019 – 2025

Funding Source: HDR Scholarship, UQ

Chief Investigators: Angela Berkhaut, Cheryl Jones, Julia Clark, Phil Britton, Vishal Kapoor, Clare Nourse

PhD Student: Angela Berkhaut

Aim

To describe the current epidemiology, treatment, and outcomes of Herpes simplex virus (HSV) infection in neonates and young infants and HSV Central Nervous System (CNS) infection in children.

Background

Herpes simplex virus infection in infancy and in children although uncommon can be devastating with significant morbidity and mortality.

Key Clinical Challenges Include:

• Clinical presentation varies and is often non-specific.
• In children, it can lead to a milder disease involving the skin or mucous membranes to a more severe disease involving the CNS or disseminated disease.
• Despite improved diagnostics, challenges still exist in identifying children with HSV infection.

Impact

The spectrum of clinical manifestations and short and long-term outcomes need to be better defined to decrease the considerable morbidity and mortality still associated with this potentially devastating infection.

Duration: 2019 – 2025

Funding Source: HDR Scholarship, UQ

Chief Investigators: Angela Berkhaut, Cheryl Jones, Julia Clark, Phil Britton, Vishal Kapoor, Clare Nourse

PhD Student: Angela Berkhaut

Aim

The purpose of this study is to describe the current prescribing practices of parenteral aciclovir in tertiary paediatric hospitals in Australia and New Zealand. The appropriateness of aciclovir therapy with respect to the drug dose and duration will be compared to local (hospital) and national guidelines. Time to aciclovir prescription, clinical features at time of prescription, investigations performed and concordance to local (hospital), and national guidelines will be described. Confirmed neonatal HSV or HSV encephalitis cases will be further evaluated and described.

Background

The non-specific presentation of HSV infection and high risk of adverse outcomes following encephalitis or neonatal disease have driven increasing empiric prescription of aciclovir in neonates and children in America, Canada and elsewhere. Clinician threshold for commencement of parenteral aciclovir varies widely despite availability of published guidelines for both conditions.

Key Clinical Challenges Include:

• Potential consequences of increasing empiric aciclovir use include increased cost of care, increased length of hospital stay, complication of intravenous access (including extravasation injury), drug adverse effects and the development of antiviral resistance.

• There have been no contemporary published studies that have evaluated prescribing practices of aciclovir in Australia or New Zealand.
• There is a need to understand prescribing practices, to further define high-risk age groups and particular clinical features of neonatal HSV infection and HSV encephalitis to guide aciclovir use, limit unnecessary treatment and evaluate implementation of national guidelines for these conditions. 

Impact

Results will be disseminated to emergency medicine, general paediatrics, infectious diseases and critical care teams to provide education and refine guidelines. 

Duration: 2019 – 2024

Funding source: HDR Scholarship, UQ

Chief Investigators: Semira Hailu, Cameron Hurst, David Harley, Adam Irwin, Kerri Viney, Clare Nourse

PhD Student: Semira Hailu

Aims: To estimate the prevalence of Extrapulmonary Tuberculosis (EPTB) in African countries. This research further aims to investigate the relationship between incidence of EPTB in Africa and population exposure variables including BCG vaccination coverage, HIV prevalence, health care access & diabetes, stratified according to income level, time period and age group. Moreover, this research aims to identify gaps in guidelines for TB in pregnancy to inform the development of a guideline for the diagnosis, treatment, and prevention of TB during pregnancy in African countries.