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Research Groups
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National Centre for Antimicrobial Stewardship
The National Centre for Antimicrobial Stewardship (NCAS) is a health services research program that aims to improve the use of antimicrobials across animal and human health, to influence national policy, and to generate a research workforce across nurses, pharmacists, doctors and veterinarians. NCAS aims to lead and facilitate the embedding of antimicrobial stewardship (AMS) within clinical practice across diverse healthcare settings and among different practitioner groups in Australia. Its research and surveillance programs aim to improve antimicrobial prescribing by understanding prescribing behaviours through qualitative and quantitative methods, monitoring current prescribing patterns across healthcare settings, identifying targets for quality improvement, and developing interventions, new policies and practices.
Current Projects
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National Antimicrobial Prescribing Survey
The National Antimicrobial Prescribing Survey (NAPS) is a standardised auditing tool that is designed to assist healthcare facilities to assess the quantity and quality of local antimicrobial prescribing. The development and implementation of the NAPS has been undertaken through an ongoing collaborative partnership between the National Centre for Antimicrobial Stewardship and the Australian Commission on Safety and Quality in Health Care since 2013. The NAPS was developed and is administered by the Guidance Group at the Royal Melbourne Hospital, and is a program partner in the Antimicrobial Usage and Resistance in Australia (AURA) Surveillance System. The Hospital NAPS is the flagship survey and commenced in 2011. Since then, the NAPS program has grown and diversified to provide a suite of auditing tools that support the antimicrobial stewardship (AMS) workforce and meet the geographical challenges of Australian hospitals. There are several modules available: Hospital NAPS, Surgical NAPS, Hospital-in-the-Home NAPS and the Quality Improvement NAPS, which have been developed for hospitals; and the Aged Care NAPS (in partnership with the VICNISS Coordinating Centre at the Royal Melbourne Hospital), which has been developed for residential aged care facilities. A General Practice NAPS is being piloted, and a Veterinary NAPS is in development. The NAPS has become an important tool for the implementation of the objectives of Australia’s National Antimicrobial Resistance Strategy, and for supporting the appropriate and judicious use of antimicrobials.
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Tertiary
Surgical antibiotic prophylaxis was identified as the most common reason for antibiotics to be prescribed in tertiary hospitals in Australia in the NAPS performed in November 2013, and in subsequent iterations of the survey. The administration of surgical antibiotic prophylaxis is an important strategy for the prevention of surgical site infections. However, in the 2013 NAPS survey, ~50% of surgical antibiotic prophylaxis use was inappropriate, particularly because of prolonged duration or inappropriate agent selection. The Surgical NAPS program provides a more granular assessment of the appropriateness of antimicrobial prophylaxis prescribing in the surgical setting. A project within this stream focuses on surgical antimicrobial prophylaxis prescribing, using a mixed-methods approach to conceptualise factors contributing to inappropriate surgical antimicrobial prophylaxis prescribing rates. It is anticipated that by gaining further insight as to why surgical antimicrobial prophylaxis is inappropriately prescribed, more specific antimicrobial stewardship measures can be developed and implemented to improve this. Another project within this stream examines antifungal use and antifungal stewardship in tertiary hospitals, with a focus on the liver transplant setting.
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General practice
Antibiotics are among the most common medications prescribed in general practice, but there is very little information available regarding the indications for use and the appropriateness of the antibiotic prescriptions. Additionally, very little is known about how GPs learn about antibiotics, and the perceptions and attitudes that shape their prescribing behaviour. This project focuses on antimicrobial stewardship in general practice. The aims of this project are to: analyse current antibiotic prescribing by GPs; review international general practice antimicrobial stewardship frameworks; consider the views of stakeholders regarding the barriers and enablers to AMS in general practice and their potential contribution to such a framework. To gain an insight into the patterns of antibiotic use and adherence to guidelines in general practice, this project will utilise the MAGNET research platform to analyse clinical data that has been extracted from the clinical records of patients attending general practices in the inner eastern region of Melbourne. The researchers will also conduct qualitative interviews with GPs to understand their workflows and the barriers and enablers to evidence-based prescribing of antibiotics. The findings from both the quantitative and qualitative studies will be used to inform the development of novel interventions that can guide GPs' decision-making around antibiotic prescribing and address the education needs of GPs to support their decision-making. NCAS is implementing a pilot GP NAPS survey to assess prescribing practices in this setting.
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Aged care
Research suggests that residential aged care facilities may be acting as a ‘reservoir and gateway’ for multi-drug resistant organism transmission (into hospitals and other parts of the general community). Thus, there is an urgent need to optimise the use of antimicrobials in this setting, given that inappropriate use of antimicrobials increases selection pressure for multi-drug-resistant organisms. This stream is geared towards optimising antimicrobial use in the residential aged care facilities setting, with a focus on implementing the Aged Care NAPS, a survey of antimicrobial use and infections in aged care homes and facilities in Australia. Research undertaken within this stream investigates the best ways of measuring antibiotic consumption in aged care facilities; interventions to improve antimicrobial prescribing in aged care facilities; and outcomes associated with these interventions. Researchers aim to improve the care of older people with respiratory tract infections in Australian residential aged care facilities with antimicrobial stewardship, and investigate the roles of nurses, and residents and their families in determining antibiotic use at the end of life.
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Regional and remote care
Australia is a country in which a significant proportion of the community live in rural and regional centres. Often dedicated experts are not available locally to guide antimicrobial stewardship programs in those settings. Attention is needed to establish sustainable models of care for antimicrobial stewardship in rural Australian hospitals. This group will examine available data to interrogate the quality of prescribing in rural-vs-urban hospital settings. Qualitative research will be conducted to examine models of care by interviewing key informants from sites where innovative models have been established. The aim is to describe a comprehensive model for antimicrobial stewardship in rural hospitals. The impact of the program will be evaluated using mixed methods along the following parameters: uptake/utilisation, staff acceptance, and changes in drug consumption patterns and appropriateness of antibiotic prescriptions. It is likely that this work will also inform strategies to build capacity in antimicrobial stewardship amongst local staff in rural hospitals. Training for auditing and feedback, and provision of resources as part of a package of interventions will also be a focus.
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Veterinary medicine – companion animals
While there is greater microbiological monitoring of infectious disease in companion animals as compared to farm animals, and data available within veterinary diagnostic laboratories on resistance patterns in a number of important indicator species, including Staphylococcus aureus, Staphylococcus pseud-intermedius and Escherichia coli, there is limited data available about usage patterns or the rationales behind antimicrobial usage. Through our research, we have been identifying factors driving antimicrobial prescribing in companion animal and equine practices, and have identified and designed strategies for future interventions, including improved prescribing guidelines and suitable mechanisms to ensure appropriate use; educational programs through continuing education courses; and, potentially, the incorporation of responsible prescribing into veterinary hospital accreditation programs.
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Veterinary medicine – livestock
In Australia, livestock production systems differ markedly from intensive livestock practices internationally. Usage in animal production is generally restricted to specific registered classes of antimicrobials and administration is generally for restricted periods of time in relatively isolated populations of animals. In contrast, antimicrobial usage in companion animals (dogs, cats and horses) is across a wider range of classes, within less isolated populations and in animals in near constant contact with humans. The aim of our studies has been to gain a clear understanding of the volumes of antimicrobials administered to different food animals, the specific antimicrobials used in typical herds and flocks, and the distribution of this usage over the lifetime of these animals. The indications that serve as signals to prescribers have been explored to identify those that are justifiable and those that are questionable, as well as to identify health problems that might be the focus of alternative solutions. In addition, the rationales for specific choices of drugs have been assessed and analysed in relation to the evidence available to support this use. This has assisted in identifying gaps in evidence for different prescribing patterns that can be addressed to guide improved behaviour.
Lab Team
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Director National Centre for Antimicrobial Stewardship (NCAS) | Director Guidance Group
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Deputy Director of NCAS; Director of the Guidance Group; Infectious Diseases Physician
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Dr Rodney James
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Senior Antimicrobial Stewardship Pharmacist and Project Officer
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Dr Noleen Bennett
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Robyn Ingram
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Head of the Infection Prevention and Surveillance Service (Royal Melbourne Hospital)
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Professor Glenn Browning
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Professor Mike Richards
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Guidance IT Manager
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Associate Professor Rhonda Stuart
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Dr David Kong
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Professor Danielle Mazza
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Dr Trish Peel
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Dr N.Deborah Friedman
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Dr Helen Billman-Jacobe
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Infectious Diseases and General Physician (Royal Melbourne Hospital)
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Operations Director (VICNISS)
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Consultant Infectious Diseases Physician
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Evette Buono
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Professor Frank Dunshea
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Courtney Ierano
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Jaclyn Bishop
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Karen Urbancic
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Lesley Hawes
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Leslie Dowson
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Dr Laura HardefeldtPost-Doctorate Fellow | Department of Veterinary Biosciences
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Dr Helen Crabb
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Dr Kirsten BaileyResearch Fellow in Antimicrobial Stewardship | Melbourne Veterinary School
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Dr Arjun Rajkhowa
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Dr Anna SriPhD Candidate | Melbourne Veterinary School
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Dr Amy HiiPhD Candidate | Department of Veterinary Biosciences
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Dr Ri ScarboroughPhD Candidate | Melbourne Veterinary School
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Centre for Antibiotic Allergy and Research
The Centre for Antibiotic Allergy and Research focuses on translational drug allergy diagnostics, health services interventions and antibiotic allergy clinical trials.
Other work areas include:Public Health
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Howden Group
Research from Professor Ben Howden’s group uses genomics, molecular biology, epidemiology and clinical studies to address a broad range of issues related to invasive bacterial diseases in humans, especially those caused by staphylococci, enterococci and other antimicrobial-resistant species. Additionally, working closely with scientists in the MDU PHL, they investigate the epidemiology, evolution and spread of bacterial pathogens of public health significance such as Neisseria gonorrhoea, Listeria monocytogenes, Shigella and Salmonella spp., Legionella spp., and carbapenemase-producing gram-negative bacteria.
Professor Benjamin Howden
Director Of Microbiological Diagnostic Unit (MDU) Public Health Laboratory
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Liaskos Group
The Liaskos group is primarily focused on understanding the cellular and molecular mechanisms of host-pathogen interactions, with particular focus on bacterial pathogens and bacterial membrane vesicles. We use a range of microbiology and immunology-based techniques to examine how bacterial pathogens that infect humans cause disease, and how the host detects and responds to these pathogens and their products.
Other work areas include:Immunology, Bacterial and Parasitic Infections
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McVernon Group
Jodie McVernon’s group uses established and emerging biostatistical, epidemiologic and modelling methods to address infectious diseases questions of public health relevance. We bring a suite of collaborators from animal health and ecology to provide a ‘One Health’ perspective on emerging human pathogens.
Other work areas include:COVID-19, Viral Infectious Diseases, Public Health
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Robins-Browne Group
Research in Roy’s laboratory is partly focused on how E. coli causes diarrhoea, with the aims of identifying better ways to diagnose, treat and prevent these infections. Another theme is the development of new types of antibacterial agents.
Other work areas include:Enteric infections, Immunology
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Stinear Group
Tim Stinear’s group’s research addresses priorities across four connected themes that including hospital superbugs, pathogenic mycobacteria, natural product discovery and public health genomics that aim to understand and contain the spread of bacteria causing serious human disease.
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Tong Group
Steve’s group conducts clinical trials to optimise the treatment of infections due to methicillin-resistant Staphylococcus aureus and other bacterial pathogens. He also investigates the epidemiology and genomics of streptococcal infections, hepatitis B, influenza, and antimicrobial resistance in Australian Indigenous communities.
Other work areas include:Staphylococcus aureus, Immunology, Viral Infectious Diseases, Bacterial and Parasitic Infections, Public Health
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VICNISS
The VICNISS Coordinating Centre provides a state-wide, standardised surveillance service for healthcare associated infections (HAIs) and related events. The goal of VICNISS is to monitor and reduce the incidence of HAIs, providing support for health services in Victoria. VICNISS aims to support Victorian health services to carry out international best practice surveillance and analysis, and to lead interventions for quality improvement to improve the health of all Victorians.
VICNISS provides a source of high quality data for regular performance monitoring, and for a valuable resource for the research community. Over the time of VICNISS surveillance, infection rates in key areas of focus have fallen markedly, reducing the significant financial and personal cost of these infections on both individual patients and the health system.
VICNISS collaborates with the National Centre for Antimicrobial Stewardship (NCAS), with a major involvement in aged care NAPS (ac-NAPS). VICNISS is also engaged by DHHS Residential Aged Care Services to carry out monitoring of infection control indicators in Victoria’s public residential aged care services, including participation in ac-NAPS.
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