Investigating Utility of Point-of-Care Testing Guiding Personalised Treatment to Delay Preterm Labour
|INSTITUTION:||Department of Metabolism
Digestion and Reproduction
Imperial College London
|RESEARCHERS:||Dr Nishel Shah – Principal Investigator
Dr Luke Moore – Clinical Microbiologist
Professor Anna David – Fetal Medicine
Professor Rachel Tribe – Preterm Birth/Microbiome and Inflammation Scientific Expertise
Preterm birth is the leading cause of disability in children. Global incidence is 11% and, in the UK, it is 7.9% of births (52,000), with 8,000 occuring before 34 weeks. While prevention strategies exist for women identified as high-risk, 50% of those presenting in preterm labour (PTL) have no identifiable risk factors with no effective treatment available to delay their progression to birth.
This project will assess the feasibility of using a precision-medicine base approach to identify and treat bacterial pathogens in women with or threatened PTL.
about the research
P R O M P T tests the use of new technology to potentially bring about dramatic improvements to the clinical care of women who present with premature rupture of the membranes or threatened preterm labour.
Clinically, the fast and accurate diagnosis of an infective organism and its current antibiotic-resistance status is crucial. Conventional diagnostic techniques are often too time-consuming, requiring 48-72 hours to identify the causative organism and its antibiotic sensitivity. Further, current techniques are labour-intensive, expensive, require specialist labs and personnel, and have to be centrally provided. The delay in diagnosis can be critical in severe infections such as sepsis which, if the causative organism is not determined early and effective treatment instituted promptly, can lead to septic shock, multiple organ failure and death.
Currently, after the diagnosis of preterm ruptured membranes, women are given the broad spectrum antibiotic erythromycin with no attempt to identify the infective organism, which we know is present in up to 80% of these cases, and which is very often sub-optimally treated by erythromycin.
This is an area of acute clinical need where timely and appropriate antibiotic therapy has the potential to not only save a child’s life, but also improve their chance of a normal development.
We are testing the use of relatively new, FDA-cleared molecular testing technology – currently used for the diagnosis of infectious disease – for early, speedy and more accurate diagnosis of infection at the point of care. In the context of ruptured membranes and many other pregnancy complications, the use of this new technology as an alternative to the conventional PCR testing will enable clinicians to make a more accurate diagnosis within hours at the point of care, and to base their antibiotic selection on clear evidence.
The correct antibiotic therapy can start days earlier than conventional approaches, potentially keeping babies in the womb for longer, saving lives as well as potentially reducing anti-microbial resistance.
Dr Nishel Shah
Honorary Clinical Lecturer