The research we conduct at Niagara Health has a profound impact on the health and well-being of our patients and communities, and contributes to better understanding some of the most significant healthcare challenges of our time and have the potential to benefit patients in Niagara and across Canada.
Dr. Aidan Findlater came to Niagara Health for the research opportunities it provided. He will lead clinical trials in infectious diseases.
Dr. Aidan Findlater knows the usual treatments for infectious diseases aren’t exactly modern medicine.
While the prognoses for other conditions have improved thanks to recent advances in research, most of the standards of care Dr. Findlater, an inpatient infectious diseases physician, relies on when looking after patients haven’t changed for nearly 50 years.
Take treating Staphylococcus aureus, or staph for short, a common bloodstream infection that has a relatively high mortality rate unless managed by an infectious diseases specialist. Even then, that specialist can only offer antibiotics developed half a century ago, and the mortality rate is still about 20 to 30 per cent.
“Just like with so many things with infectious diseases, how we manage it is how we’ve seen people in the 1970s and 80s treat it because that seemed to work then,” Dr. Findlater says. “So unlike cardiology where they have done robust research, with infectious diseases, it’s always what’s been done historically.”
Dr. Findlater is ready for his field of medicine to catch up. He’s even more keen to usher that progress along with clinical trials conducted at Niagara Health.
The opportunity to participate in and lead community hospital-based research that will move the needle on infectious diseases treatment is a big reason why the Saskatchewan-born doctor chose to practise here.
Niagara’s diverse patient population, compliments of the millions of people from around the world who visit the region each year, helped, too.
“I’m of the opinion infectious diseases are the most interesting diseases… and globally relevant as we saw during the pandemic,” Dr. Findlater says. “And with infectious diseases, you need to pay attention to the whole world because it’s all relevant to the local community.”
It was during the pandemic in late 2020 that Dr. Findlater arrived at Niagara Health from Joseph Brant Hospital in Burlington. At the time, the Intensive Care Unit here was preparing to get involved in the SNAP trial, a global, randomized clinical trial aimed at improving outcomes for patients with staph and “one of the most important trials being done in infectious diseases,” he says.
"I want to know when I’m giving a patient antibiotics, it’s because it’s the best course of treatment and gives the best results for patients. And the only way to know that is with clinical trials."
Advancing care in Infectious Diseases
Dr. Findlater, who is also an epidemiologist, had the opportunity to roll up his sleeves and join the SNAP research team right away, recruited to help by Intensivist Dr. Jennifer Tsang, also the Executive Director and Chief Scientist of the Niagara Health Knowledge Institute.
It’s an opportunity that might have eluded him elsewhere, he notes.
“This was an opportunity to do research with a large, international, randomized trial. I don’t think I’d have been able to get involved to that extent at a large academic hospital,” Dr. Findlater says. “Here, it’s us and the research team. There isn’t that academic hierarchy. Here, you can do research and get as involved as you want. This is a really important clinical trial in infectious diseases happening right here in Niagara and doing it as well as any academic centre. So obviously that’s why I have to stay here.”
While he’s here, Dr. Findlater will head up other clinical trials in infectious diseases. He’s the primary investigator on ATTACC-CAP, which is looking at whether blood thinners help patients with community-acquired pneumonia after such treatment was shown to be helpful in patients with COVID-19-related pneumonia.
Dr. Findlater is also leading the Bacteremia Antibiotic Length Actually Needed for Clinical Effectiveness (BALANCE+) trial, which is trying to determine the optimal antibiotic treatment duration for patients with bloodstream infection to maximize benefits, and minimize issues such as antibiotic resistance, C. difficile and other drug-related side effects.
Both trials are new to Niagara Health. The organization is also one of the first sites to recruit patients to BALANCE+. Fellow infectious diseases physicians, Dr. Karim Ali and Dr. David McCullagh, will join the research efforts while Dr. Findlater works on the making other physicians in the hospital aware of the trials to bolster patient recruitment.
Dr. Findlater does it all while still treating patients and juggling family life. It’s a big leap from the computer scientist or biotechnologist he thought he’d become when he started university. But as the son of two physicians, it was hard to escape the allure of medicine.
He caught the infectious diseases bug while doing his master’s degree in epidemiology.
“You can read about disease but you don’t have the same understanding of diseases as when you’re talking to patients day-in and day-out,” Dr. Findlater says. “Now that I’m treating infectious diseases, there are so many unknown questions. I don’t want to keep treating patients based on what we did in the 80s. I want to know when I’m giving a patient antibiotics, it’s because it’s the best course of treatment and gives the best results for patients. And the only way to know that is with clinical trials.”
Infectious diseases clinical trials at Niagara Health
Niagara Health is participating in three clinical trials in infectious diseases. They are:
ATTACC-CAP (New to Niagara Health)
The AntiThrombotic Therapy to Ameliorate Clinical Complications in Community Acquired Pneumonia study is an international randomized, controlled trial comparing the effects of heparin, a blood thinner, to the usual care interventions in patients admitted to hospital with community-acquired pneumonia.
BALANCE+ (New to Niagara Health)
BALANCE+ is a perpetual platform trial that will look at best ways to ‘de-escalate’ and ‘step-down’ antibiotic treatment (going from a broad to more specific antibiotic) in bloodstream infections caused by the gram negative bacteria. It will determine what to do when the infection is caused by bacteria on an intravenous catheter – should the catheter be removed and replaced, or should the infection be treated with antibiotics. It will also answer some key antibiotic selection controversies for some difficult to treat pathogens. As each question is answered, optimal therapies will be adopted into usual care, and new questions will be introduced into the platform of the trial. The evidence generated by BALANCE+ will improve cures for this vulnerable patient population while decreasing potential harms from using too many antibiotics for too long.
SNAP (Ongoing since 2022)
The Staphylococcus aureus bacteraemia Network Adaptive Platform trial is a global, randomized trial aimed to improve treatment outcomes for patients with Staphylococcus aureus bloodstream infections. It’s the first trial of its kind, recruiting adults, pediatric patients and youth.
