1 00:00:00,000 --> 00:00:12,760 Thanks for joining us at the Canadian Breakpoint, a Canadian infectious diseases podcast by 2 00:00:12,760 --> 00:00:15,900 Canadian infectious diseases physicians. 3 00:00:15,900 --> 00:00:20,720 I'm Summer Stewart here with Dr. Rupeena Purewal, pediatric infectious diseases physician 4 00:00:20,720 --> 00:00:22,460 in Saskatoon. 5 00:00:22,460 --> 00:00:28,320 In this episode, we are excited to welcome Dr. George Zhanel, department head for infectious 6 00:00:28,320 --> 00:00:34,360 diseases and medical microbiology at Max Rady in Winnipeg, and the research director for 7 00:00:34,360 --> 00:00:38,920 CARA, the Canadian Antimicrobial Resistance Alliance. 8 00:00:38,920 --> 00:00:44,920 Today we'll discuss CLEAR, or the Canadian Leadership on Antimicrobial Real-Life Usage 9 00:00:44,920 --> 00:00:45,920 Registry. 10 00:00:45,920 --> 00:00:46,920 Dr. Purewal. 11 00:00:46,920 --> 00:00:47,920 All right. 12 00:00:47,920 --> 00:00:48,920 Thank you, everyone. 13 00:00:48,920 --> 00:00:54,040 Welcome to another episode of our podcast, the Canadian Breakpoint. 14 00:00:54,040 --> 00:01:00,160 Today we have a very, very special guest with us, and after I do his introduction, I think 15 00:01:00,160 --> 00:01:03,400 the viewers will also feel the same way. 16 00:01:03,400 --> 00:01:09,240 So thank you, Dr. Zannell, for joining us today and taking time out of your busy schedule, 17 00:01:09,240 --> 00:01:14,040 because you're a very, very busy person, to be on the podcast. 18 00:01:14,040 --> 00:01:18,080 It's honestly an honor for us to have you on the podcast today. 19 00:01:18,080 --> 00:01:24,600 So Dr. Zannell is a microbiologist and pharmacologist who received his PhD in the Department of 20 00:01:24,600 --> 00:01:29,440 Medical Microbiology and Infectious Diseases at the Faculty of Medicine, University of 21 00:01:29,440 --> 00:01:34,680 Manitoba, and a doctor of clinical pharmacology at the University of Minnesota. 22 00:01:34,680 --> 00:01:38,720 He is presently professor and associate head in the Department of Medical Microbiology 23 00:01:38,720 --> 00:01:44,440 and Infectious Diseases, MaxRady College of Medicine, and research director of the Canadian 24 00:01:44,440 --> 00:01:47,480 Antimicrobial Resistance Alliance, CARA. 25 00:01:47,480 --> 00:01:53,560 Dr. Zannell is the founding and chief editor of the Canadian Antimicrobial Resistance Alliance 26 00:01:53,560 --> 00:01:54,560 website. 27 00:01:54,560 --> 00:02:00,560 Dr. Zannell has published over 1,100 papers, chapters, and abstracts in the area of treatment 28 00:02:00,560 --> 00:02:04,080 and prevention of infectious diseases. 29 00:02:04,080 --> 00:02:10,960 He has presented over 1,200 lectures as an invited speaker at international, national, 30 00:02:10,960 --> 00:02:16,240 and local meetings, speaking on the topics of antimicrobial resistance infections, as 31 00:02:16,240 --> 00:02:22,240 well as treatment and prevention of infectious diseases in Canada, the US, Central and South 32 00:02:22,240 --> 00:02:29,760 America, Western and Eastern Europe, including Russia, Australia, Southern and Northern Africa, 33 00:02:29,760 --> 00:02:31,640 the Middle East, and Asia. 34 00:02:31,640 --> 00:02:35,800 He has been extensively involved in treatment guidelines for a variety of infections in 35 00:02:35,800 --> 00:02:38,240 Canada, the US, and internationally. 36 00:02:38,240 --> 00:02:44,460 Dr. Zannell has received or been nominated for more than 100 teaching awards, including 37 00:02:44,460 --> 00:02:50,480 the Canadian Association for Medical Education Merits Teaching Award in 2020. 38 00:02:50,480 --> 00:02:52,480 Congratulations, Dr. Zannell. 39 00:02:52,480 --> 00:02:53,480 Thank you. 40 00:02:53,480 --> 00:03:00,320 Dr. Zannell is also a member of the Who's Who in Medical Sciences Education, and in 41 00:03:00,320 --> 00:03:06,640 2022, he was elected as a fellow of the Canadian Academy of Health Sciences in recognition 42 00:03:06,640 --> 00:03:12,280 of sustained excellence in research and teaching within health sciences. 43 00:03:12,280 --> 00:03:16,160 Participating in the Academy is considered one of the highest honours for individuals 44 00:03:16,160 --> 00:03:19,240 in the Canadian health sciences community. 45 00:03:19,240 --> 00:03:27,440 In 2022, Web of Science identified Dr. Zannell as one of the world's most influential researchers 46 00:03:27,440 --> 00:03:34,640 selected among elite group recognized for exceptional research influence, demonstrated 47 00:03:34,640 --> 00:03:41,080 by the production of multiple highly cited papers that rank in the top 1% by citations 48 00:03:41,080 --> 00:03:43,040 for the field and year. 49 00:03:43,040 --> 00:03:51,680 Also in 2022, Dr. Zannell received the Dr. Fred Aoki Career Achievement Award in recognition 50 00:03:51,680 --> 00:03:56,840 of a career of dedication and excellence in multiple domains of medical microbiology and 51 00:03:56,840 --> 00:04:04,480 infectious diseases, including research, education, clinical practice, service, and administration. 52 00:04:04,480 --> 00:04:05,480 So amazing. 53 00:04:05,480 --> 00:04:09,800 I'm so honoured to have you here today, Dr. Zannell. 54 00:04:09,800 --> 00:04:13,500 And today we're going to be talking about a very, very important topic, which is known 55 00:04:13,500 --> 00:04:19,520 as the CLEAR registry that Dr. Zannell will give us more information about. 56 00:04:19,520 --> 00:04:23,640 And so why don't we just start off, Dr. Zannell, by telling the audience a little bit about 57 00:04:23,640 --> 00:04:30,960 what CLEAR is and when it was established and how did this come about? 58 00:04:30,960 --> 00:04:34,660 How did this registry, this national registry come about? 59 00:04:34,660 --> 00:04:41,280 So Rapina, let me start by saying how delighted and honoured I am to be with you on this podcast. 60 00:04:41,280 --> 00:04:46,760 And I also apologize, my mother sent in this mini biography and I apologize. 61 00:04:46,760 --> 00:04:48,560 It just goes on and on and on. 62 00:04:48,560 --> 00:04:53,320 She didn't even put in there that I finally got out of diapers when I was 15 years old. 63 00:04:53,320 --> 00:04:54,320 Lots of accomplishments. 64 00:04:54,320 --> 00:04:56,880 I'm delighted to be with you. 65 00:04:56,880 --> 00:04:58,760 So CLEAR, let's talk CLEAR. 66 00:04:58,760 --> 00:05:07,400 CLEAR stands for the Canadian Leadership on Antimicrobial Real Life Usage Registry. 67 00:05:07,400 --> 00:05:10,560 CLEAR, C-L-E-A-R. 68 00:05:10,560 --> 00:05:14,200 And how this came about, it came about in 2019. 69 00:05:14,200 --> 00:05:21,000 It was traveling extensively across Canada before COVID, speaking at every hospital and 70 00:05:21,000 --> 00:05:29,560 university about new IV antimicrobials in Canada, their properties, et cetera. 71 00:05:29,560 --> 00:05:35,640 And colleagues would stop and talk to me and one of them was Dr. Ted Steiner, an ID doc 72 00:05:35,640 --> 00:05:36,640 in Vancouver. 73 00:05:36,640 --> 00:05:40,600 And he said, you know what, it's great you're talking about these antibiotics and you're 74 00:05:40,600 --> 00:05:46,480 doing research on them, but when they come to Canada, we need some sort of platform, 75 00:05:46,480 --> 00:05:51,160 infectious disease specialist, medical microbiologist, clinical pharmacologist, when they're using 76 00:05:51,160 --> 00:05:56,200 these drugs, they can actually share their experiences with other Canadians. 77 00:05:56,200 --> 00:06:03,000 And that way we know in the Canadian setting, treating patients with the Canadian antimicrobial 78 00:06:03,000 --> 00:06:09,820 resistance rates we have, how are we using these drugs, for what infections, what pathogens, 79 00:06:09,820 --> 00:06:13,960 and you should do something, he said to me, and that's how it all started. 80 00:06:13,960 --> 00:06:14,960 That's fantastic. 81 00:06:14,960 --> 00:06:21,040 And honestly, I think having that, I think the emphasis on having real life experience 82 00:06:21,040 --> 00:06:23,720 and real time experience. 83 00:06:23,720 --> 00:06:25,480 And I think we've talked about this before. 84 00:06:25,480 --> 00:06:34,120 It's fantastic that this information is presented to prescribers and it's real time data. 85 00:06:34,120 --> 00:06:41,000 So we can actually use this information in that moment, especially when all of us are 86 00:06:41,000 --> 00:06:46,680 being exposed to such new drugs and don't have a lot of data or information. 87 00:06:46,680 --> 00:06:52,280 So obviously this is a very, very new approach and it's a fantastic approach. 88 00:06:52,280 --> 00:06:57,920 So in terms of what are some of the advantages that you've, since the establishment, what 89 00:06:57,920 --> 00:07:02,360 are some of the advantages of such a registry do you think in Canada, besides having that 90 00:07:02,360 --> 00:07:05,200 real time information? 91 00:07:05,200 --> 00:07:14,360 So what we've got currently sitting in front of us is about 360 participants nationally. 92 00:07:14,360 --> 00:07:20,920 Half of those are infectious disease medical microbiology and the other half are clinical 93 00:07:20,920 --> 00:07:26,280 pharmacists specializing in infectious diseases, antimicrobial stewardship. 94 00:07:26,280 --> 00:07:32,840 And these individuals, every two, three months, get the latest information of how these antibiotics 95 00:07:32,840 --> 00:07:34,760 are being used from us. 96 00:07:34,760 --> 00:07:40,560 So what we're doing is we're sharing the information that they themselves have told us. 97 00:07:40,560 --> 00:07:47,240 So we have data submitters across Canada, pharmacists, infectious disease specialists. 98 00:07:47,240 --> 00:07:50,600 They submit data when they use these antibiotics. 99 00:07:50,600 --> 00:07:54,200 We crunch it and every two, three months we send them all the data. 100 00:07:54,200 --> 00:08:01,200 So it's Canadians, teaching Canadians how these antibiotics are being used in their 101 00:08:01,200 --> 00:08:02,200 hands. 102 00:08:02,200 --> 00:08:07,280 The other benefit is it's Canadians helping Canadians sharing Canadian experiences. 103 00:08:07,280 --> 00:08:13,220 And as many of us know in the infectious disease world and microbiology world is that definitely 104 00:08:13,220 --> 00:08:19,040 anti-biograms differ from different countries and our experience and access to medications. 105 00:08:19,040 --> 00:08:24,960 And so having this data for us nationally is super helpful, especially myself being 106 00:08:24,960 --> 00:08:25,960 a prescriber. 107 00:08:25,960 --> 00:08:30,920 I think this is the information that we're always looking for, especially when providing 108 00:08:30,920 --> 00:08:32,880 patient care. 109 00:08:32,880 --> 00:08:39,280 So I'm more interested to hear what type of data is being gathered in the registry. 110 00:08:39,280 --> 00:08:43,960 And you did mention that it's collaborated data. 111 00:08:43,960 --> 00:08:49,460 And so where is this data stored or how is it analyzed on your guys' end? 112 00:08:49,460 --> 00:08:58,140 So on our end, we decided in 2019 that every single new IV antibiotic that was health Canada 113 00:08:58,140 --> 00:09:03,440 approved and marketed in Canada would have on the clear registry. 114 00:09:03,440 --> 00:09:07,160 So we currently have four IV antibiotics. 115 00:09:07,160 --> 00:09:15,680 Cephalopipral, ceftozentazobactam, intravenous phosphomycin, and dalbovansin. 116 00:09:15,680 --> 00:09:22,080 And so what we do is for our 360 participants, and by the way, how do you become a participant? 117 00:09:22,080 --> 00:09:23,080 It's free. 118 00:09:23,080 --> 00:09:28,320 You send Zanelle an email and just say, hey, make me a part of clear, boom, it's done and 119 00:09:28,320 --> 00:09:30,000 you're a part of clear. 120 00:09:30,000 --> 00:09:31,000 That's awesome. 121 00:09:31,000 --> 00:09:35,080 And if you choose to submit data, that's fantastic. 122 00:09:35,080 --> 00:09:37,100 But you're going to be educated. 123 00:09:37,100 --> 00:09:41,400 So for these four IV antibiotics, we have a link. 124 00:09:41,400 --> 00:09:47,120 And we send out to all of our participants, if they have treated a patient with one of 125 00:09:47,120 --> 00:09:52,840 these new drugs or will treat a patient, you hit that link and it's easy peasy. 126 00:09:52,840 --> 00:10:01,360 It's three minutes on your own iPad, laptop, desktop, 17 questions pop down and it's point 127 00:10:01,360 --> 00:10:02,360 and click. 128 00:10:02,360 --> 00:10:03,720 You're done in three minutes. 129 00:10:03,720 --> 00:10:07,640 And it's asking you things like, well, what infection are you treating? 130 00:10:07,640 --> 00:10:10,000 What is the pathogen? 131 00:10:10,000 --> 00:10:14,400 Are you using the antibiotic alone or in combination? 132 00:10:14,400 --> 00:10:16,160 What dose are you using? 133 00:10:16,160 --> 00:10:19,940 By the way, did you do antimicrobial susceptibility testing? 134 00:10:19,940 --> 00:10:23,600 And if so, what method, what was the M.I.C. 135 00:10:23,600 --> 00:10:24,980 Why did you use it? 136 00:10:24,980 --> 00:10:27,640 Was it because of resistance to other antibiotics? 137 00:10:27,640 --> 00:10:30,140 Is it because you failed previous therapy? 138 00:10:30,140 --> 00:10:32,880 Was it because of intolerance to other agents? 139 00:10:32,880 --> 00:10:35,160 Microbiologically, did it work? 140 00:10:35,160 --> 00:10:37,040 Clinic, did it work? 141 00:10:37,040 --> 00:10:39,240 Were there adverse effects? 142 00:10:39,240 --> 00:10:43,160 So you point, click, point, click, point, click, you are done. 143 00:10:43,160 --> 00:10:47,240 And then what we do is the data is stored on red cap. 144 00:10:47,240 --> 00:10:50,200 This is electronic data capture system. 145 00:10:50,200 --> 00:10:53,560 And Melanie Baxter in our group is the guru. 146 00:10:53,560 --> 00:10:55,320 She crunches it all. 147 00:10:55,320 --> 00:11:00,800 And then we put PowerPoint slides together, send it out to the group. 148 00:11:00,800 --> 00:11:08,120 We also present ideally each year a poster on every drug at AMI, at the AMI CACBID meeting. 149 00:11:08,120 --> 00:11:11,360 And then we also publish papers. 150 00:11:11,360 --> 00:11:16,520 Once we get to about 30 to 50 patients, we'll actually write up a paper and publish it. 151 00:11:16,520 --> 00:11:21,080 So we've done that for all of the antibiotics already, except double bands. 152 00:11:21,080 --> 00:11:23,600 And we have yet to publish a paper on this. 153 00:11:23,600 --> 00:11:27,360 We presented a poster because we're still not where we want in terms of the numbers 154 00:11:27,360 --> 00:11:28,360 of patients. 155 00:11:28,360 --> 00:11:29,360 That's fair. 156 00:11:29,360 --> 00:11:33,560 And when you say that in terms of number of patients, what is the threshold that you're 157 00:11:33,560 --> 00:11:36,920 hitting before this data becomes finalized? 158 00:11:36,920 --> 00:11:41,680 Rupina, the threshold is whatever Jordan Zanell thinks the threshold is. 159 00:11:41,680 --> 00:11:43,000 It's terrible. 160 00:11:43,000 --> 00:11:51,400 So I've kind of set a bar of if we hit 30-ish, 20, 30 patients, we'll put a poster together 161 00:11:51,400 --> 00:11:55,840 at AMI so Canadians can see what's going on. 162 00:11:55,840 --> 00:12:00,120 Even well before that, we crunch the data, send it to all the participants, even if it's 163 00:12:00,120 --> 00:12:01,420 only patients. 164 00:12:01,420 --> 00:12:06,840 But once we start to hit around 50, the journals get interested because then you start some 165 00:12:06,840 --> 00:12:08,200 substantial data. 166 00:12:08,200 --> 00:12:16,400 So once we hit 50, we published a paper on cephtalbibral, we published a paper on cephtalzentazo, 167 00:12:16,400 --> 00:12:23,040 we published a paper on Intravenous Phosphamycin, and we're still not at 50 for the Dalbovansin, 168 00:12:23,040 --> 00:12:25,320 but once we're there, we'll publish a paper on that. 169 00:12:25,320 --> 00:12:29,160 But there is no hard and fast rules, but that's kind of the threshold. 170 00:12:29,160 --> 00:12:30,800 Yeah, no, that's fantastic. 171 00:12:30,800 --> 00:12:36,880 And you kind of mentioned that you're really looking at novel IV antibiotics. 172 00:12:36,880 --> 00:12:42,600 So in terms of, is there other criteria in how you decide which medications to review? 173 00:12:42,600 --> 00:12:49,680 No, so my criteria really are if you're a new IV antibiotic, health Canada approved 174 00:12:49,680 --> 00:12:53,520 and you're on the market, we want you in clear. 175 00:12:53,520 --> 00:12:57,440 So try not to bias and say, we don't want this one, we don't want that one, we want 176 00:12:57,440 --> 00:12:58,440 them all. 177 00:12:58,440 --> 00:13:04,360 But I will tell you, when intravenous amoxicillin clavulinate came to the market, which was 178 00:13:04,360 --> 00:13:10,080 relatively recently, I hummed in a hard whether I should put this on the clear registry. 179 00:13:10,080 --> 00:13:13,040 And initially I thought, well, of course it should be. 180 00:13:13,040 --> 00:13:16,960 But then a colleague said to me, we know exactly how it's used. 181 00:13:16,960 --> 00:13:23,480 It's used like the oral, which we've had for 35 years, when you can't use the oral. 182 00:13:23,480 --> 00:13:25,400 So didn't put it on the clear registry. 183 00:13:25,400 --> 00:13:29,280 And yet I have some colleagues bugging me to say, hey, put it on there. 184 00:13:29,280 --> 00:13:33,200 So it may actually, in fact, join the registry sooner than later. 185 00:13:33,200 --> 00:13:39,480 Yeah, I think honestly being, so I'm a pediatric infectious disease physician and so amoxiclav, 186 00:13:39,480 --> 00:13:41,880 we use a lot. 187 00:13:41,880 --> 00:13:47,900 And I think there is a different, I guess there is a couple of indications where sometimes 188 00:13:47,900 --> 00:13:53,420 I feel more comfortable using the IV version and IV amoxiclav, for instance, if you do 189 00:13:53,420 --> 00:13:59,220 have a polymicrobial infection where you're not necessarily worried about pseudomonas. 190 00:13:59,220 --> 00:14:05,120 And I think it's some of that information that's really good to disseminate because 191 00:14:05,120 --> 00:14:11,440 sometimes we don't really think about using amoxiclav in an initial setting like that, 192 00:14:11,440 --> 00:14:15,760 but remembering that the IV formulation, or again, just knowing that there is an IV formulation, 193 00:14:15,760 --> 00:14:22,320 because I think that is some data that hasn't been, I guess, widely spread just because 194 00:14:22,320 --> 00:14:25,000 it is a novel agent or a novel formulation. 195 00:14:25,000 --> 00:14:35,200 Well, you've inspired me, Rupina, this summer to put a proposal together to put IV amoxiclav 196 00:14:35,200 --> 00:14:36,560 onto the clear registry. 197 00:14:36,560 --> 00:14:43,840 I'll put together the 17 important questions we need to ask and run it by the clear group 198 00:14:43,840 --> 00:14:46,680 that we have across Canada, get their input. 199 00:14:46,680 --> 00:14:48,320 You may get an email yourself. 200 00:14:48,320 --> 00:14:52,440 Oh, I'm already joining, so there's no doubt about that. 201 00:14:52,440 --> 00:14:58,000 You can get an email, are these the best questions or should we add or delete, have other questions? 202 00:14:58,000 --> 00:15:03,920 But perhaps this fall, we should have IV amoxiclav join the clear registry. 203 00:15:03,920 --> 00:15:08,880 Yeah, and I think it's important also from an adverse event standpoint, right? 204 00:15:08,880 --> 00:15:12,240 Different formulations may have different adverse effects, right? 205 00:15:12,240 --> 00:15:16,860 Or how quick, for instance, bone marrow suppression may occur, et cetera. 206 00:15:16,860 --> 00:15:22,760 So I think it's important if something is new and novel, because I know that people 207 00:15:22,760 --> 00:15:25,360 definitely are looking out there for data. 208 00:15:25,360 --> 00:15:27,080 I'm always doing that as a prescriber. 209 00:15:27,080 --> 00:15:28,440 Thank you so much. 210 00:15:28,440 --> 00:15:32,360 You've inspired me and you've made strong cases. 211 00:15:32,360 --> 00:15:38,640 We're going to do whatever we can to put IV amoxiclav on the clear registry this fall. 212 00:15:38,640 --> 00:15:39,640 Awesome. 213 00:15:39,640 --> 00:15:44,680 And just like how you informed me that right now, so do you inform participants that are 214 00:15:44,680 --> 00:15:47,480 newer drugs are being added to the registry for review? 215 00:15:47,480 --> 00:15:54,120 So do they receive an email for once they are a participant in the registry? 216 00:15:54,120 --> 00:15:58,720 Do they receive an email once a new questionnaire comes on the market? 217 00:15:58,720 --> 00:15:59,720 Yes. 218 00:15:59,720 --> 00:16:05,600 So it's a balancing of not wanting to bombard them because everyone gets so many emails. 219 00:16:05,600 --> 00:16:07,320 I don't want them to shut down. 220 00:16:07,320 --> 00:16:13,960 I'll typically send somewhere around three to four emails a year and it's always loaded 221 00:16:13,960 --> 00:16:15,680 with here's the new information. 222 00:16:15,680 --> 00:16:20,200 Here's the slides of the four drugs for your information. 223 00:16:20,200 --> 00:16:22,320 And then if there are new developments. 224 00:16:22,320 --> 00:16:28,080 So for example, recently when intravenous Dalba Vansin came onto the market, we immediately 225 00:16:28,080 --> 00:16:32,760 sent an email to all the participants saying great news. 226 00:16:32,760 --> 00:16:38,120 Dalba Vansin has been Health Canada approved and is marketed with this indication. 227 00:16:38,120 --> 00:16:41,920 Here is the clear link to IV Dalba Vansin. 228 00:16:41,920 --> 00:16:46,760 If you have treated or will treat a patient with this drug, please consider joining. 229 00:16:46,760 --> 00:16:50,520 And again, as always, it's voluntary, but it's ethics approved. 230 00:16:50,520 --> 00:16:54,280 We're not asking for any confidential patient information. 231 00:16:54,280 --> 00:16:56,400 Please consider joining. 232 00:16:56,400 --> 00:17:00,960 And we frequently get emails back saying, oh, I didn't even know it was on the market. 233 00:17:00,960 --> 00:17:03,640 We're serving an educational tool at times. 234 00:17:03,640 --> 00:17:04,640 Exactly. 235 00:17:04,640 --> 00:17:08,000 I think a lot of that is that's very important, right? 236 00:17:08,000 --> 00:17:12,040 Because it's really important to know which medications are out there. 237 00:17:12,040 --> 00:17:18,920 And then also knowing the detail of data that you're providing, including indications and 238 00:17:18,920 --> 00:17:25,120 contraindications and really uses and anecdotal experience from our colleagues. 239 00:17:25,120 --> 00:17:31,080 I think that there's multiple times in a day when I'm practicing, when I have to reach 240 00:17:31,080 --> 00:17:37,160 out to friends across the nation to ask questions about this. 241 00:17:37,160 --> 00:17:41,680 And so what better way to do this than in a registry where people have already inputted 242 00:17:41,680 --> 00:17:42,680 this data. 243 00:17:42,680 --> 00:17:47,240 So I think this is honestly fantastic and it's the future of Canada. 244 00:17:47,240 --> 00:17:49,840 And I think it's great to have local data. 245 00:17:49,840 --> 00:17:50,840 So I'm very impressed. 246 00:17:50,840 --> 00:17:53,800 Rupina, you said something really important. 247 00:17:53,800 --> 00:18:01,840 It's this almost unexpectedness when you actually start to crunch the data per drug. 248 00:18:01,840 --> 00:18:09,200 You think you know what's going on in Canada and you realize you don't because the users 249 00:18:09,200 --> 00:18:16,760 of drugs inform you what they're doing and it's on label, it's off label, all types of 250 00:18:16,760 --> 00:18:17,760 dosing. 251 00:18:17,760 --> 00:18:22,560 There are clear partnerships with infectious diseases and clinical pharmacy using, you 252 00:18:22,560 --> 00:18:27,680 know, renal function to customize dosing and optimize pharmacodynamics. 253 00:18:27,680 --> 00:18:33,680 So it's very educational when you find out what's going on by crunching the data, what 254 00:18:33,680 --> 00:18:35,080 Canadians are doing. 255 00:18:35,080 --> 00:18:40,480 And so currently which centers or participants, I think you mentioned over 300 participants. 256 00:18:40,480 --> 00:18:43,120 And so is it pretty much national? 257 00:18:43,120 --> 00:18:47,200 You have representation from most provinces? 258 00:18:47,200 --> 00:18:48,320 Representation from all provinces. 259 00:18:48,320 --> 00:18:56,000 It's been, I was a little bit shocked and surprised that the uptake was so vigorous 260 00:18:56,000 --> 00:18:57,600 and so positive. 261 00:18:57,600 --> 00:19:01,000 Other countries have tried this and they have not been able to make it work. 262 00:19:01,000 --> 00:19:04,480 But you know, in Canada, I think we all kind of love each other and realize that we're 263 00:19:04,480 --> 00:19:07,320 just a bunch of Canadians who were born somewhere else. 264 00:19:07,320 --> 00:19:09,000 So we contribute. 265 00:19:09,000 --> 00:19:18,320 So coast to coast, I'm going to say 98% of all the participants are infectious disease, 266 00:19:18,320 --> 00:19:20,680 microbiology and clinical pharmacy. 267 00:19:20,680 --> 00:19:29,800 And then we've got sprinklings of intensivists, respirologists, internists, just other groups. 268 00:19:29,800 --> 00:19:34,600 I'm going to say about 98% of the participants are Canadian. 269 00:19:34,600 --> 00:19:39,240 But interestingly enough, we have a bunch of people from all over the world, from Italy 270 00:19:39,240 --> 00:19:42,960 and Chile and South Africa following the clear registry. 271 00:19:42,960 --> 00:19:48,760 I don't know if they're Canadians working off site or just colleagues interested in 272 00:19:48,760 --> 00:19:52,800 antimicrobial usage, but that's the demographic. 273 00:19:52,800 --> 00:19:59,480 In terms of data submitters, the people who actually point and click, it's 50-50. 274 00:19:59,480 --> 00:20:04,480 Half of the submissions are infectious disease, microbiology, half are clinical pharmacists. 275 00:20:04,480 --> 00:20:06,520 And frequently these groups are working together. 276 00:20:06,520 --> 00:20:10,240 They just say, look, I'll submit the data on this patient. 277 00:20:10,240 --> 00:20:13,520 I frequently get asked, well, what about duplications? 278 00:20:13,520 --> 00:20:15,300 We don't have duplications. 279 00:20:15,300 --> 00:20:20,840 We look for them very, very carefully, but clearly the team is talking to each other 280 00:20:20,840 --> 00:20:25,200 and saying, hey, why don't you enter this data on the clear registry? 281 00:20:25,200 --> 00:20:26,200 Yeah. 282 00:20:26,200 --> 00:20:27,200 And that's fantastic. 283 00:20:27,200 --> 00:20:32,240 I think for listeners as well to know that it's not just physicians that are part of 284 00:20:32,240 --> 00:20:33,240 the registry. 285 00:20:33,240 --> 00:20:41,260 And we do have really anybody that's involved in prescribing and who's aware and working 286 00:20:41,260 --> 00:20:45,600 in that multi, and most of us are working in a multidisciplinary team environment these 287 00:20:45,600 --> 00:20:46,600 days. 288 00:20:46,600 --> 00:20:51,280 And so we have pharmacists on board and other specialties as well. 289 00:20:51,280 --> 00:20:57,840 So I think it's nice to know that anybody could be involved who knows some information 290 00:20:57,840 --> 00:20:59,420 about the medication. 291 00:20:59,420 --> 00:21:05,320 So I think some of our audience are probably more eager to know some of the data. 292 00:21:05,320 --> 00:21:10,600 So why don't we walk through maybe one of the medications that you guys have reviewed 293 00:21:10,600 --> 00:21:18,120 and just have a quick data synopsis for one of the medications that you have reviewed 294 00:21:18,120 --> 00:21:19,480 in the clear registry. 295 00:21:19,480 --> 00:21:21,160 It's a great idea. 296 00:21:21,160 --> 00:21:23,640 And I'm going to start with ceftobiprol. 297 00:21:23,640 --> 00:21:28,320 The reason is this is the drug that really started the clear registry. 298 00:21:28,320 --> 00:21:34,640 When it came out, colleagues were asking, who's using this drug and what for, and this 299 00:21:34,640 --> 00:21:37,520 really drove the development of clear. 300 00:21:37,520 --> 00:21:39,840 So it's a good drug to start with. 301 00:21:39,840 --> 00:21:47,760 So ceftobiprol, we have had, we've now published a couple of posters at AMI, a paper in the 302 00:21:47,760 --> 00:21:49,980 journal of global antimicrobial resistance. 303 00:21:49,980 --> 00:21:54,680 We crunched the data in May, sent it out to all the clear participants, but this is the 304 00:21:54,680 --> 00:21:59,120 excitement of it, of what you find out how this drug is being used. 305 00:21:59,120 --> 00:22:05,840 So to give you a little bit of data, our clinicians in Canada using intravenous ceftobiprol, well, 306 00:22:05,840 --> 00:22:10,760 first of all, it's mostly for adults, but we do have some pediatric data to the clear 307 00:22:10,760 --> 00:22:11,760 registry. 308 00:22:11,760 --> 00:22:16,400 It is primarily used because of resistance to other agents. 309 00:22:16,400 --> 00:22:22,080 So clinicians, because of resistance to other drugs, they choose ceftobiprol. 310 00:22:22,080 --> 00:22:27,400 What kind of infections are being treated with ceftobiprol on label, health candidate 311 00:22:27,400 --> 00:22:29,820 approved indications and non. 312 00:22:29,820 --> 00:22:31,840 It's everything under the sun. 313 00:22:31,840 --> 00:22:40,560 Arcteremia, a lot of endocarditis, bone and joint infections, hospital acquired pneumonia, 314 00:22:40,560 --> 00:22:47,520 community acquired pneumonia, central nervous system infections, all types of infections, 315 00:22:47,520 --> 00:22:55,240 but it's being used almost invariably as directed therapy when a clinician grows MRSA. 316 00:22:55,240 --> 00:23:03,000 Okay, all of the cases, these are documented infections caused by MRSA. 317 00:23:03,000 --> 00:23:10,120 And typically the patient is not responding to vancomycin or not responding to Dapto my 318 00:23:10,120 --> 00:23:11,120 son. 319 00:23:11,120 --> 00:23:16,240 Indian clinicians are saying, I'm going to add ceftobiprol to the treatment. 320 00:23:16,240 --> 00:23:22,560 They don't take away the bank or Dapto add the ceftobiprol to treatment. 321 00:23:22,560 --> 00:23:28,240 So whether you've got endocarditis or a vector in your bone and joint or a pneumonia documented 322 00:23:28,240 --> 00:23:34,480 to be caused by MRSA, they start ceftobiprol treatment. 323 00:23:34,480 --> 00:23:36,840 And then you have these other interesting things. 324 00:23:36,840 --> 00:23:41,520 Do you do antimicrobial susceptibility testing? 325 00:23:41,520 --> 00:23:48,520 More than a half of the center said, no, we don't need to know from the can war data, 326 00:23:48,520 --> 00:23:53,960 the national can war data, all of the MRSA are susceptible to ceftobiprol. 327 00:23:53,960 --> 00:23:56,500 So we know the answers, it will be susceptible. 328 00:23:56,500 --> 00:23:58,320 So half of them don't even do it. 329 00:23:58,320 --> 00:24:03,080 The other half do, discs, e-tests, whatever they're doing. 330 00:24:03,080 --> 00:24:09,120 And then it comes down to the dosing and the dosing is fascinating because I'm going to 331 00:24:09,120 --> 00:24:16,400 say about two thirds of the time it's 500 milligrams every eight hours, but in almost 332 00:24:16,400 --> 00:24:23,520 everyone it's the prolonged two hour longer infusion as per the label to optimize the 333 00:24:23,520 --> 00:24:24,520 pharmacodynamics. 334 00:24:24,520 --> 00:24:31,040 And then the other third, it is being dosed in relation to renal function. 335 00:24:31,040 --> 00:24:36,600 Every single patient who's being treated with ceftobiprol has had their creatine clearance 336 00:24:36,600 --> 00:24:38,280 calculated. 337 00:24:38,280 --> 00:24:44,000 So this is what I talked about, clinical pharmacy working with infectious diseases and customizing 338 00:24:44,000 --> 00:24:47,160 the treatment to that patient. 339 00:24:47,160 --> 00:24:52,880 And then when you get into the outcomes, the microbiological success astonishingly is over 340 00:24:52,880 --> 00:24:53,880 90%. 341 00:24:53,880 --> 00:24:54,880 Wow. 342 00:24:54,880 --> 00:24:58,840 The clinical cure rates are around 85%. 343 00:24:58,840 --> 00:25:04,040 And these are patients who've been failing vancotes, failing DAPTO. 344 00:25:04,040 --> 00:25:10,200 They've got MRSA in the blood, they've got MRSA endocarditis, bones, lungs, and they're 345 00:25:10,200 --> 00:25:11,200 being treated. 346 00:25:11,200 --> 00:25:16,320 I don't want to call it as salvage therapy, but they failed the initial therapy. 347 00:25:16,320 --> 00:25:18,320 Now it's being added on. 348 00:25:18,320 --> 00:25:24,440 And surprisingly, they're doing astonishingly well knowing that over 90% of these patients 349 00:25:24,440 --> 00:25:25,440 are back to remit. 350 00:25:25,440 --> 00:25:26,440 Right. 351 00:25:26,440 --> 00:25:31,760 Whether it's the pneumonia or endocarditis or whatever, the vast majority are back to 352 00:25:31,760 --> 00:25:32,760 remit. 353 00:25:32,760 --> 00:25:36,040 They're doing well microbiologically. 354 00:25:36,040 --> 00:25:39,240 We're eradicating the organism and clinically they're doing well. 355 00:25:39,240 --> 00:25:45,280 And then on the adverse effects side, we basically got the news that we expected it's a beta 356 00:25:45,280 --> 00:25:46,280 lactam. 357 00:25:46,280 --> 00:25:48,380 It's a cephalosporin. 358 00:25:48,380 --> 00:25:50,440 So the safety has been outstanding. 359 00:25:50,440 --> 00:25:54,900 We've had a couple of patients with gastrointestinal intolerance. 360 00:25:54,900 --> 00:26:03,280 We had one patient with some hypersensitivity, but none of the three necessitated drug discontinuation. 361 00:26:03,280 --> 00:26:06,640 You know, for me, I always ask, well, I know you've had a side effect. 362 00:26:06,640 --> 00:26:07,960 Did you stop the drug? 363 00:26:07,960 --> 00:26:09,840 You don't stop the drug. 364 00:26:09,840 --> 00:26:14,600 It means the side effect was reasonably tolerated and you decided to persevere. 365 00:26:14,600 --> 00:26:17,520 So lots of exciting data. 366 00:26:17,520 --> 00:26:21,560 We know when it's being used, how it's being used. 367 00:26:21,560 --> 00:26:24,360 The outcomes are quite good and it's safe. 368 00:26:24,360 --> 00:26:25,840 Yeah, that's fantastic. 369 00:26:25,840 --> 00:26:31,680 I mean, Justin, a few of those sentences there, I mean, definitely gave me more information 370 00:26:31,680 --> 00:26:33,480 as to when to use septibipral. 371 00:26:33,480 --> 00:26:37,920 And I think really the role of the registry and the purpose of the registry is to provide 372 00:26:37,920 --> 00:26:44,480 this real time data and give us information on when can we use it. 373 00:26:44,480 --> 00:26:48,360 Because I think that's always the question, especially when you're in a crunch like that, 374 00:26:48,360 --> 00:26:54,720 when you have a patient that's not responding, you know that there's not very many drugs 375 00:26:54,720 --> 00:26:57,440 out there that are going to treat MRSA. 376 00:26:57,440 --> 00:27:04,960 And so having more information on a drug that you can add for combination therapy, I think 377 00:27:04,960 --> 00:27:10,200 from a prescriber standpoint, the comfort of having such data also and knowing that 378 00:27:10,200 --> 00:27:15,600 there is success rates of more than 90% is such helpful information. 379 00:27:15,600 --> 00:27:20,620 And the great news is this isn't American data or data from Italy or Spain or France 380 00:27:20,620 --> 00:27:21,940 or South Korea. 381 00:27:21,940 --> 00:27:25,920 This is what your colleagues are doing across the country in neighboring Alberta, neighboring 382 00:27:25,920 --> 00:27:29,840 Manitoba, British Columbia to Newfoundland, Ontario, Quebec. 383 00:27:29,840 --> 00:27:31,240 This is what we're all doing. 384 00:27:31,240 --> 00:27:32,240 No, that's fantastic. 385 00:27:32,240 --> 00:27:33,240 Yeah. 386 00:27:33,240 --> 00:27:39,840 You did mention, and this is just out of interest because I'm a pediatric subspecialist. 387 00:27:39,840 --> 00:27:44,800 And so in terms of some of these medications, I mean, it's always a challenge for getting 388 00:27:44,800 --> 00:27:53,760 dosing for us and further knowing which indications because we extrapolate most of our data from 389 00:27:53,760 --> 00:27:59,900 adult data just because there aren't a lot of RCTs in pediatrics. 390 00:27:59,900 --> 00:28:06,500 And so within the same data, do you include the pediatric data and then provide that to 391 00:28:06,500 --> 00:28:14,680 all physicians or is that only if somebody is specifically interested in having access 392 00:28:14,680 --> 00:28:18,120 to the pediatric data or is this all combined? 393 00:28:18,120 --> 00:28:22,960 We do make it clear that there's pediatric use to all of our participants. 394 00:28:22,960 --> 00:28:29,320 I've got a lot of really important women in my life, a really important person, Dr. Joanne 395 00:28:29,320 --> 00:28:35,360 Embry, who was my boss for 12 years here in the medical school for a long time, pediatric 396 00:28:35,360 --> 00:28:40,960 infectious diseases specialist like yourself, would always say to me, kids are not little 397 00:28:40,960 --> 00:28:41,960 adults. 398 00:28:41,960 --> 00:28:42,960 No. 399 00:28:42,960 --> 00:28:44,240 They're different. 400 00:28:44,240 --> 00:28:47,580 And it stuck with me for the last 35 years. 401 00:28:47,580 --> 00:28:52,360 So unfortunately, as you know, we frequently forget about children when it comes to antimicrobial 402 00:28:52,360 --> 00:28:53,360 development. 403 00:28:53,360 --> 00:28:57,640 We study adults, frequently more men than women. 404 00:28:57,640 --> 00:29:01,480 And we say, well, we think this is appropriate guidance for everyone. 405 00:29:01,480 --> 00:29:08,640 So we're late to the game with studying children, dosing efficacy or their unique side effects. 406 00:29:08,640 --> 00:29:12,120 And many of these drugs are not even indicated to be used in children. 407 00:29:12,120 --> 00:29:17,820 But like most things, clinicians in Canada don't really necessarily care what all the 408 00:29:17,820 --> 00:29:19,560 indications are. 409 00:29:19,560 --> 00:29:22,640 Their job is risk versus benefit. 410 00:29:22,640 --> 00:29:30,720 In my patient, if I think the benefit of using septobiprote or setozintazobac, or intravenous 411 00:29:30,720 --> 00:29:36,680 phosphomycin or dalbovansin, if the benefit outweighs my perceived risk, I'm going to 412 00:29:36,680 --> 00:29:42,040 use it in this patient for this infection or this age group, even though it may be off 413 00:29:42,040 --> 00:29:43,040 label. 414 00:29:43,040 --> 00:29:45,040 So I did find it somewhat surprising. 415 00:29:45,040 --> 00:29:48,640 But yes, we share the pediatric data with the participants. 416 00:29:48,640 --> 00:29:52,920 Whatever data we get, it goes to them and they see it. 417 00:29:52,920 --> 00:29:53,920 Okay. 418 00:29:53,920 --> 00:29:57,200 And I think just for our listeners, I think this is also important for especially the 419 00:29:57,200 --> 00:30:03,640 pediatricians out there, is that being part of this registry is going to be helpful for 420 00:30:03,640 --> 00:30:04,840 us too, right? 421 00:30:04,840 --> 00:30:10,940 And so I think encouraging that more pediatric data be inputted into the registry and analyzed 422 00:30:10,940 --> 00:30:12,920 similar to adult data. 423 00:30:12,920 --> 00:30:18,440 I think that really, for me, would be helpful in the coming years, especially as we're seeing 424 00:30:18,440 --> 00:30:21,800 more antimicrobial resistance in the younger populations. 425 00:30:21,800 --> 00:30:26,120 Well, Rapina, you got me all excited today because I think intravenous amoxicillin and 426 00:30:26,120 --> 00:30:31,960 clavulinate could be what ignites our pediatric infectious disease specialists across Canada 427 00:30:31,960 --> 00:30:35,480 to clear even more. 428 00:30:35,480 --> 00:30:36,480 That's great. 429 00:30:36,480 --> 00:30:38,840 So we know a little bit more about the future of the registry. 430 00:30:38,840 --> 00:30:39,840 So what else? 431 00:30:39,840 --> 00:30:40,840 What else is what's new? 432 00:30:40,840 --> 00:30:42,680 Like, what are we bringing in? 433 00:30:42,680 --> 00:30:45,080 What other newer drugs are coming in? 434 00:30:45,080 --> 00:30:53,280 So my vision is what I would like to happen is that a typical IV antibiotic is on the 435 00:30:53,280 --> 00:30:57,960 registry maximum two to three years. 436 00:30:57,960 --> 00:31:05,200 And once we've had two to three AMI posters over the years, a paper or two, we've presented 437 00:31:05,200 --> 00:31:11,960 this data in hospitals across Canada, our clear participants have had slide package 438 00:31:11,960 --> 00:31:13,880 after slide package. 439 00:31:13,880 --> 00:31:18,320 At some point, there's a time where clinicians in Canada say, well, this is not a new agent 440 00:31:18,320 --> 00:31:19,320 anymore. 441 00:31:19,320 --> 00:31:20,360 We know how to use it. 442 00:31:20,360 --> 00:31:21,840 We know when to use it. 443 00:31:21,840 --> 00:31:25,040 And I'd like to see it fall off the registry. 444 00:31:25,040 --> 00:31:28,440 And I'd like to see new drugs come into the registry. 445 00:31:28,440 --> 00:31:34,120 So I would love two, three years once you've been in, you fall off the registry. 446 00:31:34,120 --> 00:31:39,320 And then ideally every single new antimicrobial that comes in joins the registry. 447 00:31:39,320 --> 00:31:41,240 So what could be the future? 448 00:31:41,240 --> 00:31:46,520 You've inspired me with a box club, so I will get on that over the summer. 449 00:31:46,520 --> 00:31:51,440 But we're trying to work, we're working, we're doing research with all the companies and 450 00:31:51,440 --> 00:31:58,320 trying to convince in the pen and Rella back down, Merrill Pen and Vabor back down, has 451 00:31:58,320 --> 00:32:05,740 it in Abbey back down, so fitter a call potentially a tree and Abbey back down, which just got 452 00:32:05,740 --> 00:32:10,000 approved in the United States and many others come to Canada. 453 00:32:10,000 --> 00:32:14,680 You know, in Canada, these agents are not going to be used a lot. 454 00:32:14,680 --> 00:32:19,720 They're going to be used within the context of an antimicrobial stewardship program by 455 00:32:19,720 --> 00:32:21,820 specialists. 456 00:32:21,820 --> 00:32:27,720 But we know that the special access program doesn't work well for acute infectious diseases. 457 00:32:27,720 --> 00:32:33,520 When Dr. Rupina has a patient with a multi drug resistant pathogen and they're critically 458 00:32:33,520 --> 00:32:39,920 ill, you can't wait five days or eight days for this drug to come from Health Canada. 459 00:32:39,920 --> 00:32:44,040 You need to have the drug used within an hour or two. 460 00:32:44,040 --> 00:32:49,560 So we're trying to convince companies that Canada is important, bring these agents to 461 00:32:49,560 --> 00:32:50,560 Canada. 462 00:32:50,560 --> 00:32:55,000 We really need them in select cases to maximize patient outcomes. 463 00:32:55,000 --> 00:33:00,320 So every single one of the new ones that comes in, we're going to have them join clear. 464 00:33:00,320 --> 00:33:05,440 We're going to help Canadians educate other Canadians of how and why these drugs are being 465 00:33:05,440 --> 00:33:06,440 used. 466 00:33:06,440 --> 00:33:12,480 And I'm hoping this is a mobile process, so drugs are coming out, drugs are coming in, 467 00:33:12,480 --> 00:33:16,600 and it just keeps moving forward over the next several years. 468 00:33:16,600 --> 00:33:17,600 Yeah. 469 00:33:17,600 --> 00:33:21,900 And I think you bring a very important point to, you know, to the front of the list here 470 00:33:21,900 --> 00:33:27,240 is that we really need newer agents and we need data on newer agents. 471 00:33:27,240 --> 00:33:33,080 And I think some of the approvals are always lacking because we don't have local national 472 00:33:33,080 --> 00:33:34,080 data. 473 00:33:34,080 --> 00:33:42,240 But because we are looking at these medications in real time, I think that provides us with 474 00:33:42,240 --> 00:33:47,800 even a stronger case to bring in such drugs into Canada and have them at our fingertips 475 00:33:47,800 --> 00:33:54,520 when we are in a tight situation where we are struggling to manage a patient. 476 00:33:54,520 --> 00:34:01,500 So I think that's really another advantage of such a registry that's national. 477 00:34:01,500 --> 00:34:02,500 You're absolutely right. 478 00:34:02,500 --> 00:34:09,080 And I can tell you from traveling again within Canada post COVID, the infectious disease 479 00:34:09,080 --> 00:34:11,280 community is relatively small. 480 00:34:11,280 --> 00:34:13,640 We all know each other coast to coast. 481 00:34:13,640 --> 00:34:20,240 And there's a real need for some of these new agents to be used in select cases. 482 00:34:20,240 --> 00:34:24,960 Clinicians would like them on the shelf, ready to go if and when I need them. 483 00:34:24,960 --> 00:34:28,560 The good news is that I think Health Canada really understands this as well. 484 00:34:28,560 --> 00:34:29,560 Yeah. 485 00:34:29,560 --> 00:34:32,680 I've been to Health Canada several times over the last few years. 486 00:34:32,680 --> 00:34:36,440 I've presented some of our national Canward resistance data. 487 00:34:36,440 --> 00:34:39,400 They get resistance is a problem in Canada. 488 00:34:39,400 --> 00:34:41,040 We have ESDLs. 489 00:34:41,040 --> 00:34:42,240 We have CREs. 490 00:34:42,240 --> 00:34:43,320 We have MRSA. 491 00:34:43,320 --> 00:34:44,320 We have VRE. 492 00:34:44,320 --> 00:34:47,320 We have multi-drug resistance pseudomonas. 493 00:34:47,320 --> 00:34:50,420 We have these pathogens and we need some new treatments. 494 00:34:50,420 --> 00:34:53,320 They understand the need for new antimicrobials. 495 00:34:53,320 --> 00:34:59,960 They're ready to partner with industry to facilitate the approval process. 496 00:34:59,960 --> 00:35:05,720 I think we just need some bold companies to want to come to Canada, say, look, I know 497 00:35:05,720 --> 00:35:11,680 the patient clientele will be small, but we need to do this for Canada and we'll find 498 00:35:11,680 --> 00:35:12,860 a way to make it work. 499 00:35:12,860 --> 00:35:20,100 And I'm confident that with our strong infectious disease community in Canada, Health Canada 500 00:35:20,100 --> 00:35:24,560 working together with industry, we'll find a way to get this done. 501 00:35:24,560 --> 00:35:25,560 Yeah, exactly. 502 00:35:25,560 --> 00:35:29,960 Well, thank you, Dr. Zanel so much for being such a strong advocate for all of us prescribers 503 00:35:29,960 --> 00:35:36,520 because I know that all of us every single day are talking about this, but sometimes 504 00:35:36,520 --> 00:35:42,240 you just don't have the pathway to how do you get to getting a new drug approved? 505 00:35:42,240 --> 00:35:48,300 And so I think the clear registry is one of those gateways and I'm super excited that 506 00:35:48,300 --> 00:35:53,640 we have such a registry and I'm also excited to hear all about this because now I'm aware 507 00:35:53,640 --> 00:35:56,240 of it and I can share this information. 508 00:35:56,240 --> 00:36:02,000 And that's what I would suggest to our viewers today is share with others that there is something 509 00:36:02,000 --> 00:36:05,400 like a registry like this that exists within Canada. 510 00:36:05,400 --> 00:36:11,960 It's a very easy process and it's really information spreading and it's important for us to have 511 00:36:11,960 --> 00:36:13,840 such important data locally. 512 00:36:13,840 --> 00:36:18,520 Rupina, for me, three quick thank yous, a big one to you. 513 00:36:18,520 --> 00:36:21,720 I'm super honored to be part of this podcast with you. 514 00:36:21,720 --> 00:36:23,600 I was delighted when you emailed me. 515 00:36:23,600 --> 00:36:26,640 Thank you so much and thank you for what you're doing with your podcasts. 516 00:36:26,640 --> 00:36:34,320 Two, thanks to your listeners for listening and perhaps even joining CLEAR and being a 517 00:36:34,320 --> 00:36:36,040 participant or data submitter. 518 00:36:36,040 --> 00:36:40,560 And lastly, I want to thank the CLEAR participants and the data submitters. 519 00:36:40,560 --> 00:36:43,440 Without them, you and I are not talking. 520 00:36:43,440 --> 00:36:47,880 Without them, it's just George Zanell intellectually masturbating, but they're the ones who actually 521 00:36:47,880 --> 00:36:48,880 do all the work. 522 00:36:48,880 --> 00:36:54,840 So I'm really thankful to Canadian clinicians, infectious disease specialists, clinical pharmacists, 523 00:36:54,840 --> 00:36:59,360 microbiologists for everything they are doing to make CLEAR such a success. 524 00:36:59,360 --> 00:37:00,360 Thank you. 525 00:37:00,360 --> 00:37:01,360 Thank you to all of them. 526 00:37:01,360 --> 00:37:02,360 Yeah, no, that's great. 527 00:37:02,360 --> 00:37:03,360 Of course. 528 00:37:03,360 --> 00:37:07,440 And so for, I guess, our listeners out there, I know you mentioned last time that it's just 529 00:37:07,440 --> 00:37:09,360 a quick email to yourself. 530 00:37:09,360 --> 00:37:15,400 So is this email something that they can find online for you and then just email you and 531 00:37:15,400 --> 00:37:16,880 be part of the registry? 532 00:37:16,880 --> 00:37:17,880 Absolutely. 533 00:37:17,880 --> 00:37:25,440 So, you know, you can just Google George Zanell, Z-H-A-N-E-L and you'll find it right there. 534 00:37:25,440 --> 00:37:37,400 Or you know, it's G G Zanell, Z-H-A-N-E-L at PCSinternet.ca. 535 00:37:37,400 --> 00:37:41,840 And the email says, hey, CLEAR, C-L-E-A-R, I want to join. 536 00:37:41,840 --> 00:37:43,360 Boom, it's done. 537 00:37:43,360 --> 00:37:44,360 Awesome. 538 00:37:44,360 --> 00:37:45,520 That's fantastic. 539 00:37:45,520 --> 00:37:49,440 And then I know you did mention that previously because there's no demographics or patient 540 00:37:49,440 --> 00:37:51,480 information that's being shared. 541 00:37:51,480 --> 00:37:56,600 So I don't think that centers would have to have any prior like ethics approval from their 542 00:37:56,600 --> 00:37:58,320 center to be part of the registry. 543 00:37:58,320 --> 00:37:59,520 Is that correct? 544 00:37:59,520 --> 00:38:03,020 We have had no center tell us this is a problem. 545 00:38:03,020 --> 00:38:04,020 We are ethics approved. 546 00:38:04,020 --> 00:38:09,640 We took it through the University of Manitoba, but there are there's absolutely no patient 547 00:38:09,640 --> 00:38:12,200 identifiers that we are requesting. 548 00:38:12,200 --> 00:38:14,520 No confidential patient information. 549 00:38:14,520 --> 00:38:20,680 We are asking for the basics, the infection, the pathogen, the dose, all that. 550 00:38:20,680 --> 00:38:24,560 So we have never had a site say that this is a problem for them. 551 00:38:24,560 --> 00:38:25,560 That's fantastic. 552 00:38:25,560 --> 00:38:31,200 So really easy, just an email away and you know, they could, the center could be involved 553 00:38:31,200 --> 00:38:35,720 and maybe the future of the registry is to get more and more centers involved. 554 00:38:35,720 --> 00:38:41,960 So we, you know, can amplify our data and have quicker turnaround time. 555 00:38:41,960 --> 00:38:49,120 Maybe we could review medications at a quicker pace when we have larger participant involvement. 556 00:38:49,120 --> 00:38:51,640 So I think that's fantastic. 557 00:38:51,640 --> 00:38:58,320 So for our listeners and our viewers today, is there anything that one key message that 558 00:38:58,320 --> 00:39:01,960 you want to provide before we finish off this podcast today? 559 00:39:01,960 --> 00:39:09,920 I guess my only last message would be clear has been an unbelievable success story because 560 00:39:09,920 --> 00:39:14,160 Canadians, Canadian clinicians wanted to be a success story. 561 00:39:14,160 --> 00:39:22,280 And I'm just very thankful to the people who take the time to hit that link and spend the 562 00:39:22,280 --> 00:39:25,240 three minutes point and click point and click. 563 00:39:25,240 --> 00:39:30,040 And we've had tremendous success coast to coast, but you're right, the more the merrier. 564 00:39:30,040 --> 00:39:33,320 Thank you all for what you're doing with the clear registry. 565 00:39:33,320 --> 00:39:36,520 Thank you to you, Rapina for helping me advertise it. 566 00:39:36,520 --> 00:39:37,520 Of course. 567 00:39:37,520 --> 00:39:38,520 Yeah. 568 00:39:38,520 --> 00:39:40,320 It's been a fun ride with it. 569 00:39:40,320 --> 00:39:43,080 And I'm just hoping that it continues to be a success. 570 00:39:43,080 --> 00:39:44,080 All right. 571 00:39:44,080 --> 00:39:47,200 Well, we are so grateful to have you on this podcast today. 572 00:39:47,200 --> 00:39:52,300 And as I always let our viewers and listeners know that this podcast is mainly for informational 573 00:39:52,300 --> 00:39:59,080 purposes and in no way to endorse a product or in place of an infectious disease consult. 574 00:39:59,080 --> 00:40:05,800 As we kind of exit the podcast today, I really am honored to have you here today, Dr. Zanell. 575 00:40:05,800 --> 00:40:09,320 And I'm so excited for the future of clear. 576 00:40:09,320 --> 00:40:14,680 And it's honestly so fantastic because all of us want to do certain things like this, 577 00:40:14,680 --> 00:40:16,720 but you know, everybody has a busy schedule. 578 00:40:16,720 --> 00:40:23,040 You have a very, very busy schedule and you were able to establish such an important registry. 579 00:40:23,040 --> 00:40:25,240 And so we're super thankful. 580 00:40:25,240 --> 00:40:28,320 And it's really an honor to have you today. 581 00:40:28,320 --> 00:40:29,320 Thank you again. 582 00:40:29,320 --> 00:40:30,320 Thank you, everyone. 583 00:40:30,320 --> 00:40:33,400 Thank you, Dr. Pirwal and Dr. Zanell. 584 00:40:33,400 --> 00:40:44,040 For more information on the clear registry and to join, please email Dr. Zanell at ggzanellatpcsinternet.ca. 585 00:40:44,040 --> 00:40:45,880 Have a topic suggestion? 586 00:40:45,880 --> 00:40:52,720 Email us at thecanadianbreakpoint.gmail.com and follow us on Twitter at CA Breakpoint. 587 00:40:52,720 --> 00:41:19,720 See you again soon at the Canadian Breakpoint.