​UQ's Centre for Clinical Research (UQCCR) is leading an international clinical trial to guide treatment of bloodstream infections caused by antibiotic resistant bacteria.

It is currently estimated that antibiotic resistance accounts for around 50,000 excess annual deaths in Europe and the USA alone. According to a recent UK government report, by 2050 antimicrobial resistance is estimated to account for approximately 10 million deaths globally - more than are currently seen from cancer - with the greatest burden falling on developing countries in Africa or Asia.

Furthermore, this could lead to a loss of $60-100 trillion dollars in global GDP.

Under the leadership of Professor David Paterson, the research team at UQCCR aims to address the emerging global challenge of antibiotic resistance.

Dr Patrick Harris, PhD candidate with UQCCR’s Infection and Immunity theme, said the group had a particular interest in common bacteria such as E. coli or Klebsiella pneumoniae, some of which may possess resistance mechanisms called ‘extended-spectrum’ beta-lactamases (or ESBLs).

He said ESBLs are important because they are increasingly encountered in clinical infections, and in some parts of the world have become alarmingly commonplace.

“ESBLs facilitate resistance to many of our most useful antibiotics – those based on penicillin and its derivatives,” he said.

“The increasing incidence of these resistant strains often forces clinicians to employ broader-spectrum antibiotics (for instance, the carbapenem group of antibiotics) and this, in turn, may create the unwanted effect of increasing resistance to this antibiotic class.

“Once we lose efficacy of carbapenems, there are usually very few effective treatment options available.”

For patients in intensive care, or those undergoing complex procedures, antibiotic resistant infections can be devastating and are often associated with considerable excess mortality.

“The most reliable method to determine which treatment is the best option is to compare in a randomised trial, however there have been almost no such trials conducted to help clinicians determine how to treat serious infections with ESBL-producing bacteria,” Dr Harris said.

“At present, most of our knowledge relies upon laboratory findings, expert opinion or limited observational studies.

“The MERINO trial is the first ever multi-centre international randomised controlled trial to specifically test whether alternative antibiotics to carbapenems may be just as effective to treat serious bloodstream infections caused by ESBL-producing bacteria.”

To date, more than 240 patients have been recruited for the trial and the study is expanding to more than 30 hospital sites in 10 countries – a truly multi-national effort that will bolster the generalisability of the study.

The Paterson Group also conducts research into examining the genetic mechanisms giving rise to the resistance seen in these bacterial strains.

This research will provide a better understanding of how these genes are acquired and how this information can be used to design better diagnostic tests, inform infection control responses, and optimise patient treatment.

“The research network that has evolved as part of the MERINO trial also presents a unique opportunity to develop further trials in this area,” Dr Harris said.

“Many of the collaborating centres are experiencing some of the highest rates of antibiotic resistant infections in the world.

“As new antibiotic drugs are developed with activity against multi-drug resistant bacteria, it will be essential to test them in patients who are most likely to benefit.”