In our last inspirational scientist blog, David Izuogu, PhD student, University of Cambridge talked to us about his exciting work combating counterfeit products with computational chemistry. In the fifth instalment of the series Dr Andrew Conway Morris, MRC Clinician Scientist at the University of Cambridge and Honorary Consultant in Intensive Care Medicine at Addenbrooke’s Hospital, tells us how he developed a test to diagnose pneumonia. He explains how this test facilitated rapid, targeted treatment for COVID sufferers and helps avoid or limit unnecessary antibiotics.
Pneumonia
Pneumonia, an infection of the alveolar airspaces of the lungs, is a major killer. Despite recent improvements, it remains one of the commonest causes of death for children in the developing world. In addition, the recent COVID-19 pandemic has shown that it remains a major problem in the developed world as well.
Pneumonia can be caused by a wide range of microbes, including bacteria, viruses and fungi. This presents doctors with a challenge. Each of these need different treatments, and the cause cannot be easily distinguished by the examination or clinical presentation (how the patient appears). Where I work, in the intensive care unit, this becomes even more complex because patients may often have lung inflammation from other causes.
Distinguishing sterile causes from infective causes is almost impossible with current technologies. As a result of these issues, doctors will often prescribe ‘best guess’ antibiotics and see if the patient responds.
Antibiotic resistance
The world faces major problems with antibiotic resistance, increasing numbers of bacteria that cannot be treated with simple antibiotics, and a lack of new drugs in development.
When antibiotics are used in situations where they won’t work – such as in sterile lung inflammation, or infections such as viruses which won’t respond to antibiotics – we drive further antibiotic resistance and expose patients to the risk of drug side effects. Trying to find ways to make sure the right patients get the right antibiotics has been a major focus of my research work over the past decade.
Choosing a career in science
I first developed an interest in biology and medicine as teenager. I realised that I wanted to work in an applied field, being able to directly use scientific knowledge to help people while also making new discoveries, so the choice of academic medicine was the obvious career for me.
After completing an undergraduate medical and science degrees at the University of Glasgow, I moved to Edinburgh. Here, I trained in anaesthesia and intensive care, while undertaking a PhD in critical care immunology.
While investigating the immune responses to pneumonia, I identified my first test to diagnose pneumonia, using inflammatory molecules produced by the patient to detect pneumonia in ventilated patients.
Developing the test to diagnose pneumonia
I worked with a team of doctors and scientists across multiple hospitals to validate this finding (confirm that it worked in multiple settings) before undertaking a study to see if it would change antibiotic prescribing.
Frustratingly, despite the test working and accurately ruling out pneumonia, it failed to change antibiotic prescribing by doctors. Although this was disappointing, as often in science, unexpected results lead to new findings. From this study we learnt the importance of culture in clinical decision making, and that changing practice is about more than just developing a new and accurate test.
Working with the National Health Service (NHS)
Most recently I have worked with scientists from Public Health England and the University of Cambridge to develop a new diagnostic test for pneumonia that focuses on detecting the microbes.
Using polymerase chain reaction (PCR) across multiple simultaneous reactions, allows us to detect 52 different microbes, including bacteria, viruses and fungi.
I worked with NHS colleagues from intensive care and respiratory medicine to test this. I found that, not only could it provide rapid and accurate results far faster than our standard tests, but also that it changed doctors’ prescribing habits. This was very exciting, given my previous experience with the inflammatory marker test.
Implications for COVID patients
We subsequently worked with Addenbrooke’s hospital to make this test to diagnose pneumonia available to all the intensive care unit patients with pneumonia, and it really proved itself during the first wave of the COVID pandemic.
Using this test, we were able to rapidly identify patients who developed secondary pneumonia (an infection that the patient acquired in hospital), which proved to be very common among COVID patients who required intensive care. The test allows rapid, targeted treatment and helps avoid or limit unnecessary antibiotics too.
The future
I am continuing to work on developing diagnostic tests, working closely with other scientists and clinicians. Our next challenge is to find ways of getting this test out to other hospitals, as well as finding ways we can change behaviour towards antibiotic prescribing.
Seeing my work make a real and practical difference to patient care is incredibly rewarding. Although the journey is often long and seldom straightforward, it is always interesting and engaging, I wouldn’t choose another career.
If you have enjoyed this latest inspiring scientists blog about how to diagnose pneumonia and haven’t read others in the series, go back to the start and watch Taylor Uekert turn plastic waste into fuel with sunlight!
Develop the scientists of the future with new resources for Cambridge IGCSE™ Biology, Chemistry and Physics. Find out more on our science hub!
