Chris Cook, PharmD
PhD, Head, US Medical Affairs, bioMerieux
John Hurst, PharmD, BCIDP
Sr. Director, Antimicrobial Stewardship, bioMerieux
Diagnostic testing has taken centre stage as the world attempts to control COVID-19, and this technology has the power to beat antimicrobial resistance as well.
Public awareness of the need to accurately test for an infection has been heightened by COVID-19, and even more so as the northern hemisphere heads into respiratory virus season.
For Dr. John Hurst, Sr. Director of Antimicrobial Stewardship at bioMérieux, the pandemic has helped give a voice to the argument for cost-effective diagnostic investments. He says: “I think COVID-19 has taught us that it all starts with a test. Earlier and more proactive diagnostics have the potential to take one day off length of stay, making a $100 test worth thousands in savings. That’s a policymaker’s easiest decision to make.”
Global public health challenge
The World Health Organization (WHO) describes the problem of antimicrobial resistance (AMR) as a major threat to global public health. It estimates that without action, within a decade, global economies will face ruin, due to the increasing ineffectiveness of our medicines.
According to the WHO, there are countries where antimicrobial medicines are already useless in more than half of patients. This is resulting in prolonged illness in working populations, financial challenges to health systems and interruptions to food production and supply.
With emergent viruses now high on the political agenda – and signs that some viral strains are also now becoming resistant to existing treatments – never has there been a better time for health leaders to act.
However, until recently the use of rapid diagnostic technology has been limited, leaving clinicians in the empiric therapy phase to ‘guess’ what the causative pathogen of the infection is, says Dr. Chris Cook, Head of US Medical Affairs at bioMérieux. “The very first thing a clinician tries to do is determine the diagnosis and what is causing it. But until the clinician can rule out other potential causes, they’re forced to play defence and that often means giving a broad-spectrum antibiotic to cover everything it could be.”
AMR is a slow burning issue, but it has very complex effects across a wide range of activity: agriculture, hospitals, nursing homes and food production.
Affecting a global response
Several factors are important in the delivery of an effective global response to antimicrobial resistance, and for Dr. Hurst, the first of these is investment in diagnostic tests that give faster results. Effective, accurate results within minutes while the patient waits are already available. He says, “to understand why an antibiotic may not be necessary, people need to be able to walk away with objective evidence and a specific course of action.”
Secondly, health systems and organisations need to be able to share data and knowledge, for example, which pathogens are in circulation, at what scale and where to provide the evidence to inform effective clinical decision-making. Dr. Hurst says, “The technology exists already. Clinical surveillance just needs more of a political will and an investment, perhaps, to make it more of a reality. Then we can actively work to mitigate outbreaks in real-time, and strategically deploy needed resources based on data.”
Thirdly, says Dr. Cook, is the need to encourage leadership within the system to ensure everyone is working towards the same, long-term goal. He says, “The hardest thing in any type of stewardship is that you may be taking a harder course in the short-term, looking at the larger picture of consequence for the benefit of the longer-term.
“Real leadership involves supporting people towards the realisation that what’s easiest for them, may not be the best for us. Changing human behaviour is never going to be a quick and easy change like the turning of a light switch. It’s going to be a slow and gradual move, one degree by one degree.”
Unlike COVID-19, AMR is not an issue that will affect global economies overnight, but that does not mean the world can relax about its threat says Dr. Hurst. “AMR is a slow burning issue, but it has very complex effects across a wide range of activity: agriculture, hospitals, nursing homes and food production. With current projections it will far exceed the impact of COVID-19. For that reason, we must use all of the tools in our toolbox to mitigate the risk of AMR and slow its spread.”