The technology that drives world-class antimicrobial research

Globally, success stories of software technologies enabling large-scale antimicrobial management (AMS) are scarce.

There are even fewer cases of tools developed by academics and clinicians working with software engineers within a single team to deliver AMS innovations and ongoing academic research.

The inappropriate use of antimicrobials is closely linked to the emergence of bacteria resistant to antimicrobials. Photo: Annie Cavanagh / Wellcome Collection

But a pioneering team made up of the National Center for Antimicrobial Stewardship (NCAS) at the University of Melbourne and the Royal Melbourne Hospital’s Guidance Group, has grown into a multidisciplinary collaboration working on clinical and technological solutions for antimicrobial stewardship.

WHAT IS ANTIMICROBIAL MANAGEMENT?

According to the World Health Organization, antimicrobials – including antibiotics (like penicillin and tetracycline), antivirals, antifungals, and antiparasitics – are drugs used to prevent and treat infections in humans, animals and plants.

But the inappropriate use of antimicrobials is closely linked to the emergence of bacteria resistant to antimicrobials.

Fundamentally, antimicrobial stewardship aims to improve the appropriate use of antibiotics and reduce antibiotic resistance.

As leading infectious disease physicians and clinician scientists, Professors Karin Thursky and Kirsty Buising launched two award-winning, nonprofit tools, long before stewardship existed at a significant level at scale. world and Australia.

Their goal is to help clinicians make the right antimicrobial choices and help hospitals meet their management goals.

Guidance MS is an AMS decision support system that was launched in 2005 and is now in use in over 60 Australian hospitals. While the National Antimicrobial Prescribing Survey (NAPS) is an audit platform that is a key part of Australia’s National Antimicrobial Resistance Strategy – currently being implemented internationally.

Antimicrobial stewardship aims to improve the appropriate use of antibiotics and reduce antibiotic resistance. Image: Getty Images

“It is quite unique that we were able to co-develop and co-design digital AMS solutions that were effectively scaled and delivered data into the national system,” said Prof Karin Thursky, Director of NCAS, Guidance Group and one of the original founders of Guidance MS.

DEVELOPING A DECISION-MAKING SOFTWARE

The team’s journey began almost 21 years ago when Professor Thursky, then Registrar of Infectious Diseases at the Royal Melbourne Hospital (RMH), came across a 1998 article from the LDS Hospital in Salt Lake City, in Utah.

The article described a decision support system for prescribing antimicrobials in the hospital intensive care unit (ICU) and was seen as the potential “holy grail” of decision support systems. , explains Professor Thursky.

However, like so many “home” software systems at the time, it was not transferable to any other hospital.

This has sparked a continuing interest in computerized decision support systems.

Professor Raina MacIntyre, at the time chief of epidemiology at the Victorian Infectious Diseases Service, and Professor Thursky applied for a grant from the Victorian Health Department, which funded the initial decision support software, To advise. Developed and implemented in intensive care at Royal Melbourne Hospital, To advise has not only led to a reduction in the use of antimicrobials, but also to a reduction in the burden of resistant pathogens.

The project established the core team including Professor Kirsty Buising, then Registrar, who then set up the Antimicrobial Stewardship Program, now known as Guidance MS.

There is growing global concern about the impact of antimicrobial resistance on infectious disease care. Image: Getty Images

In doing so, the Guidance Group has become one of the few teams led by academics and clinicians to create a digital, on-the-ground solution for antimicrobial stewardship amid growing global concern about the impact of resistance to antimicrobials. antimicrobials on infectious disease care.

“The direction came from the evolution of AMS in Australia,” says Professor Buising. “For many young infectious disease physicians and clinicians, they sometimes don’t realize that stewardship didn’t exist fifteen or twenty years ago.

“Our group and other shop stewards were tasked with developing the argument as to why it had to exist. We then imagined and designed what ideal stewardship systems should look like.

Research meets a marriage of clinicians and software engineers

By working alongside a dedicated team of software engineers, the Guidance Group was able to design a transferable and flexible system supporting all hospital clinicians.

The team itself is made up of senior infectious disease specialists, microbiologists and pharmacists specializing in infectious diseases.

“Different levels of clinicians have completely different requirements [from stewardship systems]”says Renu Padhmanaban, chief technical officer and one of the original software developers of Guidance MS.

A transferable and flexible system has been designed to support all hospital clinicians. Image: Getty Images

“Working with clinicians, who are themselves the end users, means we can integrate all of these needs and provide a simple solution. “

Professor Thursky says Guidance MS provides clinicians with national point-of-care antimicrobial prescribing recommendations and triage patients who may need to be seen by management teams.

“If you think of a 500-bed hospital where about 40% of patients take an antibiotic, there’s no way, with current funding levels, that stewardship can see all of these patients without a support system. “, she says.

As Guidance MS rolled out to selected hospitals, the team was also able to provide a 360-degree execution strategy that helped hospitals set up their own management programs.

Independent research on the system has found results such as increased prescribing relevance, time savings, reduced spending on antimicrobial drugs, as well as a proven reduction in resistance and infection levels.

In partnership with the Australian Department of Health, NAPS has been adopted nationally as part of the National Antimicrobial Resistance and Use Surveillance Program.

Today it is used in Canada and New Zealand, as well as in hospitals in Malaysia, Papua New Guinea, United Kingdom, Bhutan, Nepal, Vietnam, Fiji and Timor- Leste.

MS Guidance will integrate better with electronic medical records in many hospitals, nationwide. Image: Supplied

Collaborations of a different kind

The NCAS Animal Health Management team led by Professor Glenn Browning and his team from the School of Veterinary and Agricultural Sciences at the University of Melbourne is also exploring digital solutions such as natural language processing and machine learning to support antimicrobial stewardship.

Meanwhile, Guidance MS is also being completely redesigned with the ability to better integrate with electronic medical records in many hospitals, nationwide. The system is also being used to support a virtual AMS model in rural and regional hospitals, such as Goulburn Valley Health in rural Victoria.

“There is a huge disparity in healthcare across Australia, in part because of geographic challenges,” says Professor Thursky.

It continued to adapt to the needs of AMS programs, in particular the requirement for effective audit and feedback.

Meanwhile, the NAPS program provides a rich source of data that informs current hospital, jurisdictional and national strategies.

Thanks to this team and their robust large-scale research that resulted from the practical application, Australia is now recognized globally for its systemic efforts to improve antimicrobial prescribing across the country’s health system. .

Banner: Getty Images


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