As a practicing Infectious Diseases and Infection Prevention and Control physician and scientist, I am highly motivated to find better ways to prevent healthcare associated infections. My research interest and focus is therefore the prevention of healthcare associated infections.
My first program of research aims to determine ways to prevent transmission of vancomycin resistant Enterococci (VRE), antibiotic resistant organisms that primarily spread in hospitals. Historically, there was no consensus among hospitals within Canada (and worldwide) on how to best prevent the spread of VRE. This was mainly due to a paucity of high quality studies on the issue. Accordingly, VRE control programs were heterogeneous and there was disagreement over best practice.
Given the controversy, and the need to have a more standardized approach to VRE control in Ontario hospitals, Public Health Ontario invested in a series of studies aimed to inform future guidance. I therefore developed a program of research to inform VRE control best practices by answering four questions:
- does discontinuing VRE infection control practices lead to an associated change in rate of VRE bacteremia
- are outcomes different between patients with VRE bacteremia versus vancomycin susceptible Enterococci
- what are risk factors for VRE bacteremia
- what health service costs are associated with VRE bacteremia.
My second program of research is focused on the prevention of ventilator associated pneumonia and other healthcare associated infections in the critically ill.
I currently co-lead the PROSPECT Trial, a multi-center, multi-national trial testing whether administration of probiotics reduce ventilator associated pneumonia and other healthcare infections in critically ill, mechanically ventilated patients. This large trial involving 44 intensive care units in Canada, the United States and Saudi Arabia completed enrolment of the targeted 2650 patients in March 2019.
We aim to complete terminal statistical analyses, manuscript preparation and submission to a high impact journal by Winter 2020. I am mentored by the co-lead of the trial, Dr. Deborah Cook (Critical Care physician and veteran trialist, McMaster University).
Once the trial is complete, and the primary paper published, we will have a robust dataset that captures detailed clinical data on a cohort of 2650 critically ill patients including comorbidities, antimicrobials used, infections during their intensive care unit stay (and associated microbiology and susceptibility patterns), and outcomes. Additional cohort studies are already planned, including predictors of ventilator associated pneumonia and predictors of Clostridium difficile infection.
In terms of future research direction, in addition to completing my two programs of research, I am part of the Public Health Ontario - Institute for Clinical Evaluative Sciences (ICES) team of physicians and scientists that are cleaning the microbiology results within the Ontario Laboratory Information System (OLIS).
OLIS is a dataset that captures all routinely collected microbiology specimens in the province of Ontario, and the OLIS dataset has recently been integrated into ICES, which allows the linkage of OLIS to all ICES databases. Once cleaned, we will be uniquely poised to capitalize on linkable Ontario-wide laboratory and healthcare administrative datasets.
There are very few jurisdictions in the world which have access to population-wide microbiology test results. Once complete, this powerful dataset will allow researchers to determine the population-level prevalence and incidence of any microbe, including antibiotic resistant organisms and emerging pathogens, as well as describe their clinical characteristics and attributable mortality in an efficient, comprehensive way. We have recently secured CIHR funding and have hired a full time epidemiologist to begin cleaning the data; we estimate the full dataset will be ready for use in 2-3 years.