When antimicrobials (also known as antibiotics) were widely introduced in the 1940s and 1950s, they were often called “miracle drugs” because they could successfully treat a broad range of common infections as well as more difficult bacterial diseases such as tuberculosis. Since then, this medical innovation has saved millions upon millions of human lives around the globe.
Today, that miracle is fading. Due to overuse or incorrect use of antimicrobials, some strains of bacteria have developed resistance to antimicrobial treatment. Scientists are alarmed that if the trend continues, we may enter a “post-antibiotic era”1 when even minor cuts or infections can prove fatal.
Roche and 12 other leading healthcare companies are collaborating on a new roadmap for a sustainable solution to the urgent issue of antimicrobial resistance, including four key commitments to be delivered by 2020. A United Nations General Assembly meeting on antimicrobial resistance in 2016 triggered this roadmap. In addition, the World Health Organisation (WHO) has a global action plan with five strategic objectives.2
Medical diagnostic tools can play a valuable role in fighting antimicrobial resistance. According to the US Centers for Disease Control, one of the most important ways is by avoiding unnecessary use of antimicrobials. Studies indicate that as much as 50% of the antibiotics used in hospitals are unnecessary.3
Data indicate that prescribers in the United States write more than twice the number of antibiotic prescriptions per 1,000 persons than some European countries.4 This trend suggests a significant number of US antimicrobial prescriptions are not necessary.
Antimicrobials kill a large number of both harmful and beneficial bacteria in the body. More resistant bacteria have a greater chance of survival, and are then more likely to multiply in an environment with less competition – a concept known as selective pressure.5 For that reason, antimicrobials should only be used when absolutely necessary.
In diagnosing patients for bacterial infections, doctors have traditionally relied on central laboratories, which can take several days to process cultures. In recent years, point-of-care (POC) diagnostics have made significant advances. These compact but sophisticated devices in physicians’ offices, emergency rooms and other healthcare facilities can deliver accurate results in a matter of minutes to guide therapy decisions.
The latest generation of point-of-care diagnostics use PCR technology (see callout box below) to give healthcare providers the right information at the right time, so they only prescribe antimicrobials when needed.
“Take the example of a throat infection caused by Strep A (Streptococcus pyogenes), which can be effectively treated with antibiotics,” explains Dan Kane, Lifecycle Leader for Roche Diagnostics. “In the US alone, people go the doctor 30-40 million times per year with a sore throat. If physicians see redness and other symptoms, they often go ahead and prescribe antibiotics – rather than wait three to four days for a conventional lab to confirm that it is Strep A. In many cases, that initial diagnosis is incorrect, and antimicrobials are not needed.”
Point-of-care diagnostics using PCR technology are changing the healthcare paradigm. Medical staff can take a swab from a patient’s throat and use a compact device to get highly accurate results on Strep A in 15 minutes. Doctors then know with a high degree of certainty whether or not they should prescribe antimicrobials.
The combination of PCR and point-of-care diagnostics can also be used to detect specific flu viruses and allow physicians to make rapid, informed decisions about prescribing anti-viral medicines.
Polymerase Chain Reaction (PCR) is a method of rapidly making many copies of a sample of DNA, for example, from blood or saliva. Once enough DNA has accumulated, automated tests can reveal the presence of a specific bacterium or virus. PCR technology, which was awarded the Nobel Prize in 1983, is recognized as one of the most important scientific advances of the 20th century, Until recently, PCR was performed at sophisticated molecular laboratories by highly skilled technicians and required several days. Next-generation PCR is now available in an easy-to-use, compact format roughly the size of a toaster. Tests performed by the regular staff of a doctor’s office can produce accurate diagnostic results in less than 20 minutes.
In countries where it is approved by regulatory authorities, point-of-care diagnostics with PCR technology can help control the dangerous problem of hospital-acquired infections. One of the most common types is C Diff (Clostridium difficile), a bacterium that causes fever, abdominal pain and diarrhea, and spreads rapidly because it is resistant to many antimicrobials. Another common type is MRSA (Methicillin-resistant Staphylococcus aureus), a bacterium that has developed resistance to a number of antimicrobials and can cause widespread infections.
Each year, some 90,000 Americans suffer from invasive MRSA infection, and about 20,000 of them die.7 According to the US Centers for Disease Control, there are nearly 500,000 C Diff infections in the US annually. In one study of patients infected with C Diff, nearly 29,000 died within 30 days of being diagnosed, and more than half of those deaths (15,000) were directly attributable to C Diff. 8
“Point-of-care diagnostics give us the power of knowing almost immediately,” says Dan Kane. “When physicians suspect a case of a hospital-acquired infection, they can test the patient right away. This minimizes the risk of contamination to hospital staff and other patients. It can also save time and money. Putting patients suspected of having C Diff or MRSA in isolation is an expensive hospital procedure. This technology can help healthcare providers make the best use of their resources.”
Point-of-care diagnostics is an important weapon in the battle against antimicrobial resistance, but it is just one part of a much bigger picture. Sustainable progress can only be made if there is a broad coalition of government, private industry and non-governmental institutions. Given the urgency of the problem of antimicrobial resistance, Roche is committed to being part of the solution.
References
WHO’s first global report on antibiotic resistance reveals serious, worldwide threat to public health, News release, 30 April 2014.
Centers for Disease Control and Prevention (2014). Overview and evidence to support stewardship: Fast facts.
Goosens, H., Ferech, M., Coenen, S., & Stephens, P. (2007). Comparison of outpatient systemic antibacterial use in 2004 in the United States and 27 European countries. Clinical Infectious Diseases, 44 (9).
Alliance for the Prudent Use of Antibiotics (APUA).
Mark R. Hughes, Deputy Director of the National Center for Human Genome Research at the National Institutes of Health (perhaps better known as the Human Genome Project).
MRSA Research Center, The University of Chicago Medicine.
C Diff Foundation.
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