Mark Miller, MD, FRCP(C)
Executive Vice-President, Chief Medical Officer, bioMérieux
As one of the top 10 threats to human health, antimicrobial resistance (AMR) should not be underestimated. The World Health Organization estimates that 700,000 people die every year from antimicrobial resistant infections.
Antibiotics have only been available to patients since the 1920s, with the discovery of penicillin. If we fail to act soon, the effects of antimicrobial (including antibiotic) misuse will be irreparable in as little as 29 years.
The 2016 report chaired by economist Jim O’Neill predicts that AMR will cause 10 million deaths per year and cost the global economy USD $100 trillion. For comparison, the COVID-19 virus has resulted in an estimated 5 million deaths worldwide since the beginning of the pandemic as of October 2021.1 This report has helped persuade healthcare stakeholders to take AMR more seriously and invest in better solutions for antimicrobial stewardship.
Increasing AMR education and stewardship
Dr Mark Miller, who is Executive Vice-President and Chief Medical Officer at in-vitro diagnostics company bioMérieux, says within a hospital setting implementing successful stewardship requires three core components: sufficient budget, knowledgeable people, and the support from multi-disciplinary staff, including the c-suite. In practice, however, he notes that stewardship implementation can vary between regions. Too often, communities may not know the severity of local AMR due to poor surveillance or reluctance to share their data.
While the goal of stewardship remains the same regardless of region, the lack of awareness and education for the behaviours contributing to AMR, regional impact, and the urgency of addressing the problem lends itself to many being “not convinced they have an AMR problem”. Dr Miller reminds us that “if we let it go on, it’s going to destroy us economically and medically.”
All you have to do is look at statistics of the amount of antibiotics that are used because of COVID to know that we are just a dynamite keg ready to explode.
Diagnostics are key
Diagnostics support the goals of stewardship by ensuring the right antimicrobial for the right patient at the right time and in the right dose for the right duration.
Optimised use of diagnostics for antimicrobial stewardship includes more rapid identification of pathogens, differentiating between bacterial and viral infections and supporting better clinical decision making with knowledge of antimicrobial susceptibility. Diagnostics provide critical surveillance data for assessing the status of AMR in a community, country or region.
“In general, diagnostics in medicine have always been undervalued and it has been said that 70% of medical decisions are based on some type of diagnostic information, but only 3% of healthcare costs are spent on diagnostics.2“
Diagnostics are emerging as one of the key tools for stewardship but collaboration across multiple disciplines is still needed to leverage integrated solutions to their full potential. The next step to improving stewardship will be increasing visibility to the power of data and analytics by connecting diagnostic data and clinicians through clinical decision support software.
COVID-19 and the future of diagnostics
The COVID-19 crisis has accelerated the issue of AMR and the full extent of the impending devastation caused by antibiotic overuse during the pandemic is not yet fully known.
“All you have to do is look at statistics of the amount of antibiotics that are used because of COVID-19 to know that we are just a dynamite keg ready to explode. Essentially three quarters of patients in hospitals are getting broad spectrum antibiotics even though they come in with a pure diagnosis of COVID-19,” he says.3
Health systems are anticipated to return focus to AMR, including monitoring that had been paused. Optimised use of diagnostics will be critical to reduce the spread of multi-drug resistant infections in the healthcare setting, where antibiotics have been in highest use during the pandemic.
“People do not grasp that if we do not control AMR, there will be no elective surgeries, chemotherapy, radiotherapy or all the procedures that we consider today to be low risk because associated infection risks will be too high.”
Dr Miller concludes: “Remember how important COVID-19 diagnostics were in the first year of the pandemic, AMR-related diagnostics are going to be equally as important as we continue to battle this global health threat.”
[1] World Health Organization, Coronavirus (COVID-19) Dashboard https://covid19.who.int/
[2] Forsman R. W. (1996). Why is the laboratory an afterthought for managed care organizations? Clinical chemistry, 42(5), 813–816.
[3] Bradley J. Langford, et al., Bacterial co-infection and secondary infection in patients with covid-19: a living rapid review and meta-analysis, clinical microbiology and infection, Volume 26, Issue 12, 2020, Pages 1622-1629, ISSN 1198-743X, https://doi.org/10.1016/j.cmi.2020.07.016.