Edinburgh Infectious Diseases
Edinburgh Infectious Diseases

Rapid diagnostics for more effective use of antibiotics

One of the keys to more effective and appropriate use of antibiotics is identifying the nature of an infection as quickly as possible.

Optical image cores produced by EPSRC-supported Proteus Project
Optical image cores produced by EPSRC-supported Proteus Project

Summary

Theme leader:  Dr Till Bachmann, Deputy Head Division of Infection and Pathway Medicine

Dr Till Bachmann

Deputy Head Division of Infection and Pathway Medicine

  • Division of Infection and Pathway Medicine
  • College of Medicine and Veterinary Medicine

Contact details

Antimicrobial Resistance (AMR) is a major threat to healthcare systems and societies on a global scale and is addressed up to the highest policy levels.  Rapid diagnostics are continuously at the top priority list of measures to combat AMR.  However, current methods are too slow and lack information depth to enable tailored therapy decisions and patient management.

Various groups in Edinburgh work on advancing diagnostics spanning clinical, biomedical, technological to social and policy aspects. Below we give key examples of the truly interdisciplinary and international approaches we take in Edinburgh to tackle this urgent need.

Examples of projects in this theme

Proteus:  Lighting up the Lung, Detecting Disease

Project leaders: Mark Bradley (School of Chemistry) and Kev Dhaliwal (MRC Centre for Inflammation Research)

Proteus is an EPSRC Interdisciplinary Research Collaboration (IRC), which is considered to be internationally-leading in the field of disruptive sensing healthcare systems and collaboration ethos.

Proteus was launched in October 2013 and consists of three collaborating institutions: the University of Edinburgh, Heriot Watt University and the University of Bath.

The multidisciplinary team is delivering a transformative fibre-based point-of-care sensing device, which will lead to significant healthcare improvement through rapid point-of-care diagnosis, patient stratification and personalised drug therapy.  In particular this will allow identification of infection in the distal lung, leading to more informed and appropriate use of antibiotics.

The team is comprised of the Project Director, 12 Co-Investigators, 18 postdoctoral researchers, plus support staff (Project Manager, Clinical Project Manager, Engagement Strategist, Business Development Executive etc.). In addition there are over 20 PhD students associated with the project.

The team have already demonstrated that the use of a fluorescence-based microendoscopy system is capable of simultaneously detecting several different pathogens in human ex vivo lung tissue. Preparations are now underway to perform the first in vivo human clinical studies, marking a huge milestone in the project timeline.

More information at the Proteus project website:

EPSRC Proteus Project

Laser driven imaging technology developed by the Proteus team
Light-emitting diodes, which will shine light down optical fibres into the deep areas of patients’ lungs.

Rapid point of care tests to combat Antimicrobial Resistance

Project leader: Till Bachmann, Division of Infection and Pathway Medicine

The Bachmann group specialises in rapid point of care tests which are urgently needed to make therapy and management decisions at the point of need. Strongly supported by funders including ITI Techmedia/Scottish Enterprise, BBSRC, MRC, Innovate UK and CSO in multiple collaborations, we have developed a strong portfolio of assays, biomarkers and technology, enabling rapid point of care testing.

Many of their tests are centred around an electrochemical biosensor platform using electrochemical impedance spectroscopy (EIS) for label-free molecular diagnostics. This covers a wide range of targets from small molecules over proteins as host biomarkers of infection to different types of nucleic acids including synthetic targets, PCR products derived from antibiotic resistance genes, microRNA, as well as genomic DNA and ribosomal RNA for direct amplification-free bacterial AMR and species identification.

The  group also runs AMR DxC - the international Antimicrobial Resistance Diagnostics Challenge competition and is coordinating the JPIAMR Rapid Diagnostic Test Transnational Working Group. Till Bachmann is member of the Advisory Panel for the Longitude Prize as well as judge for the Discovery Award.

More information is available at the websites below.

Joint Programme Initiative on AMR

Antimicrobial Resistance Diagnostics Challenge

Hand-held electrical impedance spectroscopy (EIS) device for pathogen detection.
Hand-held electrochemical impedance spectroscopy (EIS) device for pathogen detection.

Synthetic biology-enabled rapid and portable pathogen DNA detection

Project leader: Baojun Wang, School of Biological Studies

Funded by the Wellcome Trust, we are developing low-cost, rapid and portable biosensors that can provide point-of-care nucleic acid diagnostics of target disease pathogens including AMR bacteria.

As a proof-of-principle, we will design biosensors that can specifically and quantitatively report the DNA load of Mycobacterium tuberculosis (Mtb, major pathogenic agent for tuberculosis) and their AMR mutants in samples such as sputum.

DiaDev: Investigating the Design and Use of Diagnostic Devices in Global Health

Project leader: Alice Street, School of Social and Political Sciences, Edinburgh Centre for Medical Anthropology

DiaDev is a European Research Council funded project that examines the capacity of point of care diagnostic devices to strengthen health systems in resource-limited settings.

Bringing together approaches from social anthropology and science and technology studies, this ethnographic study investigates the extent to which how diagnostic devices work and what they can achieve depends on the locally specific relationships through which they are designed and used.

Device case studies from the USA, India and Sierra Leone will examine the dynamics of different global health partnership models, the integration of devices with health infrastructures in target settings, and the management and use of diagnostic data. 

A health systems perspective is important for understanding interactions between diagnostic infrastructures and antimicrobial consumption patterns, and identifying the opportunities and challenges that accompany the development of AMR-related diagnostics for global health.

Investigating Diagnostics in Global Health (DiaDev)

Alice Street, School of Social and Political Science

Women bringing their children to a health clinic
Women bringing their children to a health clinic in Sierra Leone

Sequence Based Diagnostics

Project leaders:  Mark Woolhouse and Stefan Rooke, School of Biological Sciences

Continual improvements in DNA sequencing technologies, and the associated reduction in the costs of sequencing has meant that the routine diagnosis of infections by sequence based methods are becoming increasingly viable.

Diagnostics of bacterial infections by whole-genome sequencing is particularly promising; giving species and strain identification, virulence determinants, and determining the antimicrobial resistance genes present within a much shorter time-frame than traditional microbiological techniques.

Moreover, the degree of resolution provided by sequencing is useful in its own right, showing not only the antibiotic resistance genes present but the mutations associated with them, and where in the bacterial genome they lie – either on the chromosome, or plasmids.

This information can inform healthcare surveillance programs, helping to determine the origin and potential spread of particular resistance genes; allowing for more effective action to be taken to curtail their dissemination.

Epigroup website

DAN sequencing array
DNA sequencing array