May 7, 2019

JI partners seek better way to quickly diagnose critical sepsis

Dr. VanEpps with JI colleagues in the newly opened biobank facility at PKUHSC during a visit to Beijing in January 2019.

A Joint Institute research collaboration aims to drastically shorten the diagnostic and treatment window for patients with critical sepsis infections.

Led by UMMS Assistant Professor of Emergency Medicine J. Scott VanEpps and his counterpart at Peking University Health Science Center (PKUHSC), Professor of Emergency Medicine Ya’an Zheng, the project has broad implications not only for getting antibiotics to patients who need treatment as quickly as possible, but also for reducing excessive treatment among those that don’t.

“When you have severe sepsis, every hour of delay increases mortality. But because symptoms – fever, high hear rate – are non-specific, treatment guidelines typically call for broad-spectrum antibiotics all patients who are symptomatic,” said VanEpps MD, PhD. “That helps create more resistance, in addition to unnecessarily exposing patients to these drugs that cause side effects.”

Sepsis, which costs US hospitals alone more than $20 billion each year, is typically confirmed via a blood culture test that takes at least 24 (and sometimes up to 72) hours to complete, often with nonspecific results. Van Epps’ lab has devised a new assay using polymerase chain reaction (PCR) technology, boosted by gold nanorods, that could potentially cut the diagnosis window from days to hours, with results focused enough to target specific antibiotics to the respective bacteria discovered.

While the new method has shown promise in the lab, the 2017-awarded JI project aims to begin translating the technology to the clinical setting, testing the PCR assay against traditional culture tests with patients at both Michigan Medicine and PKUHSC.

“We’ve demonstrated that this works in the perfect lab environment. The next step involves showing efficacy in the clinical setting using whole blood,” VanEpps said.

Teams in both PKUHSC and Michigan Medicine began collecting and preserving samples in late 2018, with the goal of collecting 3,000 total samples by the end of this year. VanEpps and a researcher from his lab, Erika Martinez-Nieves, MS, traveled to PKUHSC in January to check in on sample collection processes and tour Zheng’s lab facilities. Both sites will be running the tests on their respective samples.

“It’s one thing to make it work here at Michigan Medicine, but it’s another thing to implement something on the other side of the world,” Van Epps said. “You have to make sure you’re incorporating your process into their workflows and environment. If we can do that, you get results that are generalizable across the world, something that would be impossible with a US-only study.

“Because antimicrobial resistance is a worldwide problem, both of our teams are motivated to make this work on a global scale,” he said.