Q&A with U of T Pharmacy Graduate Student Christine Peragine

1. What is the topic of your PhD research

Rates of antimicrobial resistance (AMR) are increasing worldwide and represent a serious threat to modern medicine. Since antibiotic use is one of the strongest drivers of resistance, and since 20-50% of inpatient antibiotic use has been reported as unnecessary or inappropriate, hospitals across Canada (and the world) have implemented Antimicrobial Stewardship Programs (ASPs) in an effort to curtail antibiotic misuse and contain the AMR problem.

While there is a growing amount of evidence evaluating antimicrobial stewardship initiatives, there is still a shortage of high quality data examining their impact on resistance in hospital-acquired pathogens.

My PhD thesis evaluates the impact of Sunnybrook Hospital's multidisciplinary Antimicrobial Stewardship Program (ASP) on the institutional burden antibiotic-resistant bacteria and rates inpatient antibiotic use (AMU). We used a robust quasi-experimental study design called the Interrupted Time Series to compare changes in the level and trend of antibiotic resistance (AMR) and AMU in the 7 years preceding program introduction to the 7 years following implementation.

Ultimately, this project aims to produce high quality evidence demonstrating the impact of an effective antimicrobial stewardship program, providing a comprehensive assessment of the temporal relationship between antimicrobial uses of over 15 antibiotic agents/classes on the susceptibility patterns of over 15 bacterial pathogens.

2. What is the most exciting find you have discovered in your research thus far?

We are most excited to see that the implementation of our program was associated with significant and sustained reductions in the prevalence of hospital-acquired antibiotic-resistant organisms (ARO) and multi-drug resistant organisms (MDRO). We compared this to rates of resistance in community-acquired isolates, and we found that rates of community-acquired ARO and MDRO increased significantly over the same time period.

These findings are significant as many studies have demonstrated a positive impact of antimicrobial stewardship interventions on prescribing behaviors, antimicrobial use, and drug-acquisition costs, but there is a shortage of high-quality data describing the impact of these interventions on antimicrobial resistance.  This is shocking given that reducing resistance is the main reason for the establishment of these programs. In fact, as of 2013, all Canadian hospitals were mandated to have these programs in place.

3. How has this finding shaped the future direction of your research?

No two hospital’s ASPs are the same; in fact, there is no present “standard” ASP composition globally. Seeing the impact of our program on AMR, and understanding that there are significant differences between the structure of our site's ASP and the structure of other hospital's ASP’s has inspired me to want to examine the relative impact of each type of ASP on AMR. This data is also lacking, but is very important. Understanding which program has the most profound impact on AMR could be used to inform best-practice recommendations. Other trainees, such as doctors and microbiology fellows inspired by my findings, have approached me to collaborate on this type of project, but I need to finish my thesis before I can even think about the next steps!

4. How has the student experience fund helped you in your academic journey?

Without the generous support of the Enhancing the Student Experience Fund (ESEF), I would not have been able to attend the AMMI-CACMID annual conference in Vancouver to share the results of my research with key decision makers (i.e. doctors, pharmacists, hospital administrators, etc).

Attending this conference, presenting my research and interacting with experts in my field allowed me to receive valuable feedback on ways to improve my project. Also, without the financial support, I would not have been able to enter the student oral presentation competition and win! The positive responses I received validated the hard work I’ve invested into this project, and I am very grateful for the opportunity.

5. What does winning the student oral presentation competition at CACMID mean to you and your research?

Winning an award at such an important and renowned national conference is such an honour! Having always wanted to be a teacher and researcher, it was such a privilege to teach others about my work.

I invest a lot of time and effort into making my presentations engaging/compelling/interesting/inspiring; winning this award really validates my teaching and research efforts. The award tells me that I am making an important contribution to research in the areas of infectious disease and public health, and that my research has the potential to drive ASP policies, reduce AMR and ultimately improve the care of Canadians and patients all over the world.