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14 Sep 2020

Meet the team: Dr Norelle Sherry investigates patient infections from ‘bench-to-bedside’

Meet University of Melbourne Dr Norelle Sherry, clinician-researcher at the Doherty Institute and infectious diseases physician and clinical microbiologist at Austin Health and Royal Melbourne.

Can you introduce yourself and your roles?

I’m a clinical microbiologist and infectious diseases physician. My primary role is as a clinical microbiologist at Microbiological Diagnostic Unit Public Health Lab (MDU PHL), working on the implementation of genomics for clinical and public health microbiology and antimicrobial resistance (AMR) - both phenotypic and genotypic work. I also work as an ID physician at Austin Health and more recently as a clinical microbiologist at Royal Melbourne Hospital. I’m also finalising a PhD on AMR surveillance using genomics. I should have been finishing about now but was interrupted by COVID-19, like many other people’s work and personal lives currently.

You wear many hats across several organisations. What does a ‘typical’ day look like?

Pretty varied currently, although consistently lots of Zoom meetings! A lot of my role at MDU PHL is about coordination of different teams and projects, as well as ‘translating’ between different groups – clinicians, wet lab scientists, bioinformaticians, epidemiologists and researchers. So, a typical day will see me meeting and checking in with various groups, troubleshooting issues, answering enquiries and requests from external organisations, liaising with clinicians, and reporting on the progress of various projects. On other days, I get to see patients (ward rounds on patients admitted to hospital or outpatient clinics) or do more hospital microbiology work at Royal Melbourne Hospital (such as plate rounds, liaising with clinicians and attending clinical meetings).

As a clinician-researcher, you provide a bridge between clinician support and research. What are the benefits of having a dual role in this space?

It’s a really exciting role and such a privilege to be able to look at patient infections from ‘bench-to-bedside’. I think it’s useful to be able to provide the medical context for lab scientists but also to be able to explain complex science to clinicians and get them excited to be involved as well. Clinicians often want to become involved in basic and applied research but aren’t entirely sure how to make those connections.

Your expertise includes using genomics for surveillance of antimicrobial resistance in multiple different settings, and you’ve been using genomics to investigate COVID-19 in healthcare settings. What has that experience been like and what have been the challenges?

Most of our work has either focussed on the public health surveillance level, including COVID-19 and other pathogens likely carbapenem-resistant Enterobacterales, or on the hospital level with other antibiotic-resistant pathogens. In both cases, the key has been to integrate the genomics with epidemiologic data, and that involves a heavy emphasis on communication between teams with very different backgrounds, and a lot of translation! Seeing the positive impacts on public health, especially with COVID-19, has been very rewarding, as has the potential applications in healthcare settings. But there’s always more work to do to improve systems, communication and make sure that what we’re doing is actually worthwhile.

What initially attracted you to the field of infectious diseases and microbiology?

I first did a work experience placement in a microbiology lab when I was in high school and loved it so much I went back on my school holidays (yeah, definitely a science geek)! I remember how excited I was when I first saw a textbook called ‘Medical Microbiology’ – somehow it really appealed to me, even back then. I started doing biomedical science at university and was working in aged care as a part-time job as well. I really enjoyed working with people there, so I applied for medicine and transferred. Throughout my training, I kept coming back to infectious diseases, started the training then fell back in love with microbiology again. It’s been a very convoluted and scenic route but very happy to now be back to microbiology where I started.

You were involved in a comprehensive study – Controlling Superbugs – that combined genomic information with patient movement data across four Melbourne Hospitals in order to identify and control superbugs before they spread. What did your project discover and how might this knowledge be applied in clinical practice?

We looked at four main antibiotic-resistant bacteria (MRSA, VRE, ESBL E. coli and ESBL Klebsiella) and sequenced all the isolates from patients over a 15-month period. By comparing the genome sequences and correlating with epidemiologic data we were able to look in a very detailed way at transmission of these organisms between patients, which can’t be done without genomic sequencing. This data can be used by hospital teams to identify areas that need more interventions to prevent infections and is something that we’re working on rolling out more prospectively for certain bugs in some hospital networks.

What do you see as the biggest challenges or misunderstandings in your area of science?

In general, I think people don’t always understand the complexity of what other groups do. For example, many clinicians and epidemiologists who haven’t been exposed to genomics before think genome sequencing should be quick and give ‘black-and-white’ results but in reality, there are many shades of grey. Communicating that can be difficult. On the other hand, explaining the complexities of human infections, behaviour and infection control to non-clinicians can also be challenging – pretty much everything I deal with is about shades of grey and communicating this.

What achievement are you most proud of in your work?

The Controlling Superbugs study was definitely a mammoth task, getting agreement and engagement across multiple sites – it felt risky when I agreed to be the project lead, so it felt pretty good when it worked out well. Overall, it’s just been a real privilege to work with such talented teams and I learn something new every day.

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