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New tool to fight infection in the tropics

3 Dec 2021

Tropical areas across the top of Australia have a very high rate of potentially dangerous skin and other infections – and a very low level of information to support clinicians in treating these patients with antibiotics. A new digital data platform aims to fill the clinical and surveillance gap – but also to “inform policy makers to invest more time and resources in regional and rural Australia”.

That’s the aim and the hope of Dr Tere­sa Woz­ni­ak, lead researcher of the HOTspots pro­gram which enables clin­i­cians in north­ern Aus­tralia – doc­tors, nurs­es and Abo­rig­i­nal health prac­ti­tion­ers – to iden­ti­fy the right drugs for the right bugs’.

The plat­form, which pro­vides localised and time­ly infor­ma­tion about which antibi­ot­ic-resis­tant organ­isms are cir­cu­lat­ing in a giv­en local region, will join a suite of resources to sup­port clin­i­cians across north­ern Aus­tralia to man­age patients more effec­tive­ly,” says Dr Woz­ni­ak, Prin­ci­pal Sci­en­tist at CSIRO and Hon­orary Senior Research Fel­low at Men­zies School of Health Research.

We are con­stant­ly look­ing at ways to make HOTspots more user-friend­ly and pro­vide local evi­dence so that those patients who live in resource-poor set­tings, despite chal­lenges of remote­ness and high turnover of health­care staff, have equi­table access to health care.”

North­ern Aus­tralia, above the Trop­ic of Capri­corn, has a low pop­u­la­tion den­si­ty, with a lot of remote and region­al com­mu­ni­ties, and a very high bur­den of infec­tious dis­eases, says Tere­sa. Skin infec­tions pose a sig­nif­i­cant issue in the trop­ics.

Skin is your bar­ri­er to the out­side world. If that bar­ri­er is com­pro­mised, you are at a high­er risk of skin infec­tions.”

Liv­ing in remote set­tings fur­ther adds to that risk.

Skin infec­tions caused by Staphy­lo­coc­cus aureus (i.e gold­en staph) is a com­mon one, a real­ly big one. Oth­er infec­tions include uri­nary tract infec­tions which, if they go untreat­ed, can become inva­sive blood­stream infections.”

Pho­to pro­vid­ed by Men­zies School of Health Research.

Dr Woz­ni­ak point­ed out that a study by one of her PhD stu­dents found that clin­i­cians in remote areas were doing a good job, want­ed to do the right thing, but were ham­pered by a lack of resources.

In some cas­es, it takes three to four days for results to come through from pathol­o­gy to con­firm what is caus­ing the infec­tion, but remote health work­ers don’t have time for that,” says Dr Woz­ni­ak. The patient may be return­ing to their home or com­mu­ni­ty and the clin­i­cian needs to make the most accu­rate deter­mi­na­tion on the spot and decide what treat­ment and antibi­otics to use.

With improved sur­veil­lance and data from the HOTspots plat­form, clin­i­cians can visu­alise and inter­ro­gate data (by age and sex) that are rel­e­vant to the region where the patient may have acquired the infec­tion. If he or she sus­pects a par­tic­u­lar organ­ism, they have access to infor­ma­tion from the HOTspots plat­form, plus the treat­ment guide­lines and their own exper­tise, to pre­scribe antibi­otics most like­ly to work and kill the bacteria.”

While there have been some delays due to COVID-19, the plat­form is updat­ed every six months, with plans to move towards more reg­u­lar updates. HOTspots is now being used in hos­pi­tals in North­ern Ter­ri­to­ry and increas­ing­ly in region­al, rur­al and remote clinics.

The increased data col­lec­tion is an impor­tant step towards the goal of health equi­ty in Aus­tralia, says Dr Woz­ni­ak.

With research and resources, we tend to focus on where we see the most peo­ple,” she says. We sur­vey the big major hos­pi­tals and ter­tiary hos­pi­tals and know so much about what is hap­pen­ing there.

North­ern Aus­tralia is geo­graph­i­cal­ly iso­lat­ed and, in many parts, [is made up of] resource-poor set­tings which are often out­side of sur­veil­lance reach. Until recent­ly, this data had not been pro­vid­ed to treat­ing physi­cians.

We are now col­lect­ing the data, clin­i­cians are using the data – hope­ful­ly the data will also allow some peo­ple to see the hotspots of high infec­tions and which will need greater invest­ment and resources.”

HOTspots was devel­oped from fund­ing pro­vid­ed by the HOT NORTH pro­gram, an NHM­RC research pro­gram based at Men­zies School of Health Research.

Access the plat­form at this link.