"I'm one of those idealists who graduated with the goal in mind: 'That's where I want to work!'" - Dr Liselotte Hardy

What is SIMBLE?

LISELOTTE With the SIMBLE project, we are testing a new system for blood cultures. Through those blood cultures, you can detect bloodstream infections. The project name stands for 'simplified blood culture system'. Very concretely, with this project we are testing a new system adapted to the needs in Africa.

What exactly are bloodstream infections? Why are they dangerous?

LISELOTTE A bloodstream infection can occur in a very banal way. For example, because a bacterium got into your blood via a wound. Normally, your immune system will remove the bacteria, but sometimes things go wrong and the bacteria start to multiply. You then get an infection. Such a blood infection can lead to sepsis, which can be life-threatening.

What role do blood cultures play in the diagnosis of bloodstream infections?

LISELOTTE Suppose you have a high fever and go to the hospital. Among other things, blood is then drawn in a blood culture bottle. The bottle also contains a so-called growth medium. The bottle is then placed in a machine with the right temperature (body temperature) to allow the bacteria to grow. If bacteria begin to grow, there is a diagnosis of a bloodstream infection. Next, the microorganism which is causing the infection has to be identified and the best way to treat it determined.

With the SIMBLE project you are trying to provide a solution for this

LISELOTTE We have developed the Bactinsight system, which consists of two parts. The first part is a new device, the Turbidimeter. It is a simple box with an LED lamp and two sensors, into which the bottle is placed. The light bulb sends a beam of light through the bottle. The sensors interpret the beam for 'turbidity'. The cloudier, the more bacterial growth.

In a second step, we use a lens-free microscope developed by our partners in Grenoble (CEA). Once bacterial growth is determined, we place a drop on a petri dish. The lens-free microscope sits under the dish and takes a picture every 30 minutes. That allows us to identify the bacteria.

But you have also developed another important innovation - blood culture vials.

LISELOTTE Shipping the vials is very expensive and very slow. During a previous project, we analysed the different commercially available growth media to know which ones are most suitable for growing the bacteria we see most in the field. We were able to narrow it down to a very simple medium based on two powders that you mix together.

You also looked at how the vials, medium and petri dishes can be produced locally.

LISELOTTE We have a project partner in Barcelona who produces vials, among other things. Through them, we developed a shipping container in which we had a mini-factory built. So we have a mobile production environment that works entirely according to current standards, allowing clean and safe work. We shipped that to Cotonou, where it is now being used.

Will the development of SIMBLE have a direct impact on patients?

LISELOTTE Not everyone can afford a blood test. In fact, costs are usually passed on to patients. We can absorb that in the study. And by introducing the study, more patients can get a diagnosis. For example, since the study was launched in Burkina, we have seen an extremely high increase in sample collection. The number of positive diagnoses is more than double what we would expect. Such an increase tells us that even more samples should actually be collected at the hospital level. With local production, this can be done at a fraction of the current price.

How is the project funded?

LISELOTTE By EDCTP. This is European-African funding, where both European and African countries contribute. If you contribute, you get to participate as a country. We have partners in Benin, Burkina Faso, France, Spain and Belgium.

How did you come up with the idea for the project?

LISELOTTE I did my PhD at ITM with dr. Tania Crucitti. Once the project ended, I took a postdoc position at Ghent University, working with civil engineers on a chlamydia rapid test based on lab-on-chip technology. But when that project came to an end, I saw an opportunity to come back to ITM to work in the Unit of Tropical Bacteriology.

One day, I was sitting at the breakfast table with Professor Jan Jacobs in DR Congo. We were talking about blood cultures. Jan Jacobs asked if, with my background in photonics, I couldn't think of anything to improve working methods. And so the ball got rolling. I went back to my former colleague Professor Roel Baets. He was very enthusiastic to come up with a solution together.

The partners in Grenoble rolled into the project as if by chance. I had contacted them for something else. And I had been toying with the idea of local production for some time.

What is the next step in the SIMBLE project?

LISELOTTE We will work with McGill University to further develop the blood culture system. McGill has made a low-cost development for antibiotic sensitivity testing. That complements the other two parts of the project nicely. We are also thinking of using AI during growth in the turbidimeter, to start identifying the bacteria already there.

So actually to already be further along in the diagnosis during the first step?

LISELOTTE Indeed ... If that would work, and I hardly dare to say it, the impact on a global scale would be immense. We would then really have taken a big step forward.

And the production?

LISELOTTE Dissou Affolabi is already further ahead locally with scaling up production, but he has that in hand. We have already submitted a project application to expand local production to other countries, but it is difficult to find finances for this kind of project because it is capacity building rather than scientific research.