In this article two infectious diseases experts describe the importance of rapid diagnostics to fight against antimicrobial resistance in today’s inter-connected world.
Authored By: Christine Ginocchio, Ph.D., MT, (RET) & Tristan Timbrook, Pharm.D.
Article Posted: 26 October, 2021
Antimicrobial Stewardship: Who’s Responsible?
According to this year’s messaging for World Antimicrobial Awareness Week (WAAW), observed from November 18th to 24th, the answer to this question is: EVERYONE! In fact the motto for WAAW is “Everyone has a role to play” in addressing the clear and present danger of antimicrobial resistance (AMR).
As scientific and medical professionals, we know that antibiotics are a vital piece of maintaining public health, but they are rendered futile to fighting largely preventable bacterial infections as a result of AMR. And what continues to drive the spread of AMR is overuse and misuse of antibiotics. The CDC estimates that at least 30 percent of US doctors’ offices and emergency departments continue to prescribe antibiotics unnecessarily—fertile ground for a new wave of antibiotic-resistant bacteria.
Globally, 700,000 people die annually due to drug-resistant diseases, which could expand to 10 million annually by 2050 if no action is taken, exceeding heart disease, diabetes, and cancer as primary cause of mortality. While AMR is not exclusively a human consumption issue, with animal overconsumption being in fact the leading driver, we must still be prepared to take charge of the factors under our influence; as we’ve seen from the past year, the global impact of one pandemic – on both individual lives and economies alike – can be disastrous.
ONE Health, A Holistic Approach Backed by Governmental Agencies
WAAW 2021 is promoting the theme of “Spread Awareness, Stop Resistance,” and continues to encourage and advocate for multisectoral engagement in the fight against AMR—often referred to as the ONE Health Approach.
ONE Health, by definition, is a collective effort to achieve optimal health outcomes, recognizing the interconnection between humans, animals, food, and the environment. Governmental organizations such as PACCARB, the Presidential Advisory Committee for Combatting Antimicrobial Resistance, are playing a key role by supporting effective programs and policies related to combating antibiotic-resistant bacteria and applying the One Health mindset. As seen in the National Action Plan for Combating Antibiotic Resistant Bacteria, updated in 2020, there is a call for the increased use of rapid diagnostics and improved prevention, surveillance, and control efforts.
Antimicrobial Stewardship Supported by Diagnostics
Antimicrobial stewardship programs (ASP) are the best response from hospitals to improve our to improve awareness and address the threat of AMR. ASPs have revealed that when a full team of health professionals are involved in a patient’s diagnosis, the likelihood of incorrectly prescribing antibiotics often falls dramatically. In practice, this means enlisting several, multi-tiered participants in the shared responsibility of optimized patient care. Internal stakeholders, such as clinicians, lab professionals, and pharmacists, as well as external public authorities and private industry players, all have a role to play in antimicrobial stewardship.
ASPs typically factor the “six Ds”: diagnosis, debridement/drainage, drug, dose, duration, and de-escalation. The first stage of reliable diagnosis is the most important. Today’s advanced diagnostic solutions allow lab professionals to rapidly identify the source of an infection and determine antibiotic susceptibility, supporting evidence-based decision making. Additionally, there are certain nuanced detection methods for healthcare professionals to utilize such as syndromic testing in order to drill down to the most tailored antibiotic prescription. In turn, the microbiology professionals examining the patient’s samples, such as lab managers and lab technicians, are tasked with determining the presence or absence of disease-causing organisms.
Diagnostic tests coupled with analytics software, can provide real-time health data to empower more informed decision making. In particular, advanced analytic tools are available to transform the antibiogram to be automated and dynamic. Connecting diagnostic data inside US hospitals to provide vital lab and clinical data across departments, including regional surveillance and benchmarking of MDROs, provides crucial speed to insight to improve patient care from antibiotic initiation through discontinuation.
Opportunity remains for healthcare professionals to employ diagnostic solutions to their fullest potential and do their part in accelerating antimicrobial stewardship awareness and initiatives towards combating AMR.
Optimal Health for All
The spread of AMR is a serious public health concern that could, unless subdued, result in pandemic-level devastation. Therefore, the major role that diagnostics plays in global containment measures cannot be overstated. If public authorities, healthcare industries, healthcare systems, and the professionals working within them embrace the beneficial and vital practice of antimicrobial stewardship—our chances of winning the fight against AMR will significantly improve.
REFERENCES
1. World Antimicrobial Awareness Week 2021 – Spread awareness, stop resistance. https://www.who.int/news/item/26-08-2021-world-antimicrobial-awareness-week-2021-spread-awareness-stop-resistance. August 26, 2021.
2. Antibiotic Resistance and NARMS Surveillance. https://www.cdc.gov/narms/faq.html#howdoes.
3. One Health; Centers for Disease Control and Prevention. Accessed July 2021. https://www.cdc.gov/onehealth/index.html.
4. Presidential Advisory Council on Combating Antibiotic-Resistant Bacteria (PACCARB). Content last reviewed October 7, 2021. https://www.hhs.gov/ash/advisory-committees/paccarb/index.html.
5. NATIONAL ACTION PLAN FOR COMBATING ANTIBIOTIC-RESISTANT BACTERIA. October 2020. https://www.hhs.gov/sites/default/files/carb-national-action-plan-2020-2025.pdf#:~:text=The%20National%20Action%20Plan%20for%20Combating%20Antibiotic-Resistant%20Bacteria,Americans%20by%20changing%20the%20course%20of%20antibiotic%20resistance.
6. Core Elements of Hospital Antibiotic Stewardship Programs. https://www.cdc.gov/antibiotic-use/core-elements/hospital.html.
ABOUT THE AUTHORS
Christine Ginocchio, PhD, MT, (RET) Senior Vice President of Global Medical Affairs for bioMérieux and BioFire Diagnostics, serves on the Presidential Advisory Council on Combating Antibiotic-Resistant Bacteria.
Tristan Timbrook, PharmD, is the Director of Health Economics and Outcomes Research in Global Medical Affairs for bioMérieux and BioFire Diagnostics.
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