Australian Rotary Health

University of Sydney
Rotary Club of Bondi Junction
Rehabilitation of Spinal Injury
 

I was born in Malaysia and migrated to Australia in 1994. Being awarded the Australian Students Prize for Excellence in 1995 spurred me to a career in medicine. I graduated with a Bachelor of Science, Medicine and Surgery from the University of New South Wales in 2001.

After being exposed to working in a multidisciplinary allied health team consisting of mainly nurses, physiotherapists, occupational therapists and social workers during my aged care rotation as a resident in hospital, I decided to enter rehabilitation medicine training. It was during my rotation in the spinal injuries unit at the Prince of Wales Hospital that I gained an interest in research. During my term, some of the inpatients had infections with bacteria that were resistant to a multitude of conventional antibiotics. I undertake a retrospective analysis of the prevalence of multi-resistant organism (MRO) in the Prince of Wales spinal cord injuries (SCI) unit.

I found that the prevalence of MRO in our unit was similar to a spinal unit in the United States and that multi-resistant Staphylococcus aureus remains the most common bacteria that colonises a spinal patient. The emergence of multi-resistant bacteria has always been the most feared consequences of over-usage and over-exposure to antibiotics and when I was asked by Dr. Bonsan Bonne Lee to be involved in a trial looking at novel approaches to treating the problem, I leapt at the chance. Studying potential treatments, like probiotics, that could lead to better health outcomes for people with SCI is both a professional and personal quest for me.
 

People with spinal cord injury (SCI) are commonly colonized with multiresistant organism (MRO) as a result of recurrent urinary, chest and/or wound infections. MRO occur due to over-exposure to antibiotics during treatment of infections. Presence of MRO in SCI patients makes conventional treatment difficult if further infections develop as treatment usually requires prolonged hospitalization and use of more expensive drugs. MRO spreads easily to other patients within the hospital, requiring extra infection control precautions. Furthermore, transmission of MRO to patients already immunocompromised increases mortality and morbidity.  

Probiotic agents are bacterial cultures similar to that found in yogurts. Certain strains of probiotic bacteria have been shown to be possibly effective in treating MRO in other patient populations. We do not know from these studies whether this potential treatment will work for people with SCI. My PhD will primarily look at how Probiotics effect MRO colonisation as part of the PROBIOTIC PROPHYLAXIS of SPINAL CORD INJURY URINARY TRACT-INFECTION THERAPEUTIC (ProSCIUTTU) trial. This is a randomized controlled trial in 372 people with SCI which commences in mid 2010 and will run for a period of 3 years. The trial hypothesis is that Probiotics may prevent urinary tract infections in people with SCI. Unlike antibiotics, Probiotics do not cause development of further antibiotic resistance.

The other aims are:

1) To determine if Probiotics treat or inhibit MRO colonization in persons with SCI

2) Evaluate the ability of Probiotics to form protective Biofilms on top of urinary catheters and test the ability of these ‘good’ biofilms to resist intercurrent antibiotic exposure.

3) Completing a systematic review on the effectiveness of probiotics in treating and preventing MRO (including the ProSCIUTTU trial results) through the Cochrane collaboration.

 

It is important that probiotic agents are comprehensively evaluated in this regard as it could guide future preventative healthcare strategies that lead to better health outcomes for people with SCI, as well as more efficient quality management through shorter hospitalisation and avoidance of expensive antibiotics.