In this article three infectious diseases pharmacists discuss the cross-roads of antimicrobial resistance and microbiology laboratory, reflecting on a recent Twitter chat on the topic.
Authored by: Patrick McDaneld, Pharm.D., BCIDP, Brian Raux, Pharm.D., BCIDP, and Katherine Perez, Pharm.D., BCPS-AQ ID
Article Posted 25 March 2023
Active collaboration between healthcare professionals, researchers, policymakers, and the public is essential to proactively combat the threat of antimicrobial resistance (AMR). Multidisciplinary approaches to antimicrobial stewardship (AMS) are imperative to address this concerning situation. Important initiatives like World Antimicrobial Awareness Week, #ASPchat and other collaborative efforts are needed to raise awareness and provide educational support for combating AMR.
In November 2022, #ASPchat partnered with bioMérieux and their experts, Patrick McDaneld, Brian Raux and Katherine Perez to address the gravity of this worldwide health concern in a real-time, open Twitter forum, highlighting microbiology labs and how they can impact antimicrobial stewardship program (ASP) successes. Laboratorians, clinicians, and other healthcare professionals engaged to discuss the importance of essential tools for rapid diagnostics and stewardship data for effective patient care to help save lives—particularly when dealing with drug-resistant infections.
Critical Lab Results: Dealing with Drug-Resistant Infections
Infectious diseases caused by bacteria, viruses, fungi, and parasites pose a major threat to human health. The overuse and misuse of antimicrobial drugs has led to the emergence of resistant strains of these pathogens, making it increasingly difficult to treat infections. That’s why rapid lab results can help to save lives.
“Nothing is more helpful than having quick access to a patient’s previous culture results and antibiotic exposures to help dictate the right empiric choice!” #ASPchat
-Katherine K. Perez, PharmD, BCPS-AQ ID, Director, Antimicrobial Stewardship, bioMérieux
The bioMérieux experts and #ASPchat participants examined the role of rapid diagnostics in enabling proper therapeutic decisions for drug resistance infections. Pathogen identification, rapid antimicrobial susceptibility testing (AST), and culture and sensitivity testing are major contributors toward the early optimization of therapy in the patient journey.
Participants also highlighted novel tools like Improving Decision Making in Empiric Antibiotic Selection (IDEAS) individualized predictive modeling for resistance that are impacting empiric antibiotic prescribing for applying successful intervention techniques leading to a forward-looking antimicrobial stewardship program.
“On a patient-specific level, it’s the combination of genotypic or phenotypic results from a normally sterile site—blood, cerebrospinal fluid (CSF)—or in a critically ill patient [that come to mind when saving lives for patients with drug resistant infections].”
-Patrick McDaneld, PharmD, Medical Science Liaison, Clinical Infectious Disease, bioMérieux
The bioMérieux experts and chat participants all agreed that when prior results aren’t available, getting rapid susceptibility information as soon as possible is crucial.
Antimicrobial Resistance Champions
As a part of the #ASPchat discussion, participants shared creative ideas to help broaden the ripple effect of communications to better inform the world about the threat of AMR.
Participants made multiple suggestions for helping the community at large understand the severity of AMR, including: simplifying terminology and messaging, accelerating the impact of laboratory data, and even identifying potential celebrities that might be a great champion for this cause.
The #ASPchat conversation stressed the significance of making AMR more understandable—and even personal—to guide healthcare professionals in proactively communicating the critical concern of drug-resistant infections. Several participants commented that sometimes it takes a strong, impactful personal story to make a difference. It may be troublesome or even “scary;” however, these real human stories can relay the importance of AMR to others.
“AMR is scary and means many things to different people. We should look to other diseases that have had success in becoming household names and the support of patients to join in the defense of through uniform messaging and patient advocacy.”
— Brian Raux, PharmD, Medical Science Liaison, Clinical Infectious Disease, bioMérieux
The Wellcome – Reframing Resistance report was shared as a helpful guide to remove the “fear factor” tactic of sensationalizing AMR and provide recommendations for how communicators, policy makers, clinicians, and experts can inform, motivate and persuade public support towards active change. #ASPchat participants discussed how healthcare professionals can be doing a better job at the patient level explaining the fundamentals of AMR, demonstrating the unintended consequences associated with unnecessary antibiotic use.
Lab Success Testimonials
One component of the chat discussion centered around microbiologists and laboratory technicians being more visible and active contributors towards ASP initiatives at an institutional level. Lab directors and technicians are rarely seen outside of the microbiology and pathology departments; however, data research and automation for laboratories were discussed as valuable tools for allowing greater access, search, filtering and downloading of information. A greater awareness, even within individual hospitals, of the resistance genes, MRSA rates, and VRE rates generate attention and bring better techniques to resolving AMR concerns.
“Part of the problem is the lack of data at many levels. Susceptibility surveillance reporting at all levels from hospitals to country level data to multinational data is critical to understand the problem/trends, educating healthcare/public and driving decision making.”
-Patrick McDaneld, PharmD, Medical Science Liaison, Clinical Infectious Disease, bioMérieux
Labs play a vital role in AMR awareness, as they serve as a critical starting point in both stewardship initiatives and the patient journey. Brian Raux shared colleague Andrea Prinzi’s recent article in the American Society for Microbiology (ASM) in echoing the need for an interdisciplinary approach to stewardship. There is an opportunity for the laboratory and clinical teams to partner together on these initiatives to improve patient outcomes and create more effective stewardship programs.
Visual Awareness to Antimicrobial Resistance
In the concluding portion of the #ASPchat discussion, participants were asked to share micro lab resources as well as any visual examples from the lab that could aid in AMR awareness within hospitals. It was discussed that, while standard data is necessary for clear benchmarking, once those basics are in place professionals and communities need to get creative in sharing knowledge.
Participants shared engaging examples of these tools, such as this large-scale glimpse of AMR in action, educational graphics that demonstrate the importance of mitigating antimicrobial resistance, and lab geniuses quite literally dressing the part of MRSA to educate others on AMR. These examples illustrate the part that human activity is playing in accelerating this issue. Even sharing the image of half & half creamer to convey that a lab tech spends 50% of their time doing benchwork and 50% of their time providing data and analytics, helps provide context for understanding the laboratory process and workflow.
Antimicrobial resistance is a complex issue that affects everyone and requires a multidisciplinary approach. The November 2022 #ASPchat stimulated thoughtful discussion among laboratory professionals, and clinicians, which yielded valuable insights about how the microbiology laboratory can help improve stewardship initiatives and combat the growing public health concern of AMR.
ABOUT THE AUTHORS
Patrick McDaneld, Pharm.D., BCIDP is a medical science liaison at bioMérieux, focused on clinical infectious diseases. Prior to joining bioMérieux, Dr. McDaneld was an infectious diseases clinical pharmacy specialist at the University of Texas MD Anderson Cancer Center Houston, TX. In addition to participating in direct patient, he served as the antibiotic stewardship team pharmacy lead, and the infectious diseases residency program coordinator.
Dr. McDaneld recieved a Doctor of Pharmacy from the University of Colorado, Denver, School of Pharmacy. Afterward, he completed a PGY1 pharmacotherapy residency at Houston Methodist Hospital, Houston, TX, followed by a post-doctoral fellowship, in global medical affairs at Massachusetts College of Pharmacy and Health Sciences in collaboration with Cubist Pharmaceuticals, Inc. Following this, he completed a PGY2 infectious diseases pharmacy specialty residency at Houston Methodist Hospital, Houston, TX.
Dr. McDaneld’s areas of research interests include antimicrobial therapy and stewardship in immunocompromised patients, with several publications in these areas.
You can find him on Twitter @PMMabx.
Brian R. Raux, Pharm.D., BCPS, BCIDP is a medical science liaison at bioMérieux, focused on clinical infectious diseases. Before joining bioMérieux, Brian worked as a clinical pharmacist and antimicrobial steward at the Medical University of South Carolina.
Dr. Raux received a Doctor of Pharmacy degree from Northeastern University and is passionate about medical education, patient care, and advancing antimicrobial stewardship practices through clinical research.
You can find him on Twitter @Brian_Raux.
Katherine Perez, Pharm.D., BCIDP is the Director of Antimicrobial Stewardship at bioMérieux.
Dr. Perez received a Doctor of Pharmacy degree from the University of Texas College of Pharmacy in Austin, Texas in 2010. She completed a postdoctoral pharmacy practice residency in a combined program at University Health System Hospital and the Pharmacotherapy Education and Research Center at the University of Texas Health Science Center in San Antonio, Texas followed by a specialty residency in infectious diseases pharmacotherapy at Houston Methodist Hospital, Houston, Texas.
Dr. Perez is board certified in infectious diseases pharmacotherapy by the Board of Pharmaceutical Specialties. She is currently a member of several professional associations including American College of Clinical Pharmacy (ACCP), Society of Infectious Diseases Pharmacists (SIDP), Infectious Diseases Society of America (IDSA), Houston Infectious Diseases Network (HIDN), Making a Difference in Infectious Diseases Pharmacotherapy (MAD-ID), and the American Society of Health-System Pharmacists (ASHP).
Dr. Perez’s areas of research interest include antimicrobial resistance, rapid diagnostics, bacterial bloodstream infections, and antimicrobial stewardship.
You can find her on Twitter @kkpIDRx.
DISCLAIMER: The opinions and perspectives presented in this article are a collaboration of the featured authors and those that participated in the Twitter discussion and do not necessarily represent the position or policy of any past, current, or potential future employer.
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