Combat Antimicrobial Resistance Through Diagnostic Precision
PCR panels offer an effective way for clinical labs to fight the threat of AMR
Jeanie Bach MSN, RN CCRN, is a disease area partner for infectious disease at Roche Diagnostics, based in Arizona.
ViewFull ProfileLearn about ourEditorial Policies.
Jeanie Bach MSN, RN CCRN, is a disease area partner for infectious disease at Roche Diagnostics, based in Arizona.
Since their first use only a century ago, antibiotics have saved countless lives and transformed modern medicine. However, the rise of antibiotic overuse in humans and animals, coupled with a decline in antimicrobial discovery and development, has contributed to the growing threat of antimicrobial resistance (AMR).
Even as new antibiotics are developed, the constant evolution of resistant bacteria is now compromising our ability to effectively treat even common infections. While AMR continues to rise, its consequences are already grave: In 2019, bacterial AMR was directly responsible for an estimated 1.27 million deaths worldwide.
In the fight against AMR, diagnostic precision is central to effective antimicrobial stewardship. Antimicrobial stewardship, which aims to optimize the use of antibiotics, relies on the ability to accurately and rapidly identify pathogens to ensure patients receive the right treatment at the right time. The power of diagnostic precision lies in its potential to not only improve individual patient outcomes, but also to preserve the effectiveness of antibiotic use.
Antibiotics are commonly prescribed to treat acute upper respiratory infections, despite the fact that most are caused by viruses. The presence of co-circulating pathogens with overlapping symptoms, such as influenza and microplasma pneumonia, further complicate the identification and treatment landscape.
Molecular diagnostics, particularly PCR-based panels, may enhance pathogen detection and may guide more precise treatment decisions. Equipping healthcare providers in both inpatient and outpatient settings with accurate, sensitive, and efficient diagnostic tools can guide more informed treatment decisions to fight the looming threat of AMR, connecting patients with appropriate therapies and using antibiotics only when necessary.
The role of diagnostic stewardship in antibiotic stewardship
The success of antimicrobial stewardship programs hinges on the integration of diagnostic stewardship efforts. Diagnoses made based on clinical acumen alone, especially in respiratory illnesses with overlapping symptoms, cannot reliably determine a specific bacterial agent or even discriminate between bacterial, viral, or fungal infections.
For example, one study found a sensitivity of only 36 percent across influenza diagnoses made on clinical symptoms alone, compared to over 98 percent sensitivity of rapid PCR testing. This uncertainty often leads to prescription of inappropriate or broad-spectrum antibiotics, incurring unnecessary costs and contributing to antibiotic resistance.
Diagnostic algorithms are not a one-size-fits-all solution; patient presentation, history, immunocompetent status, and other factors add complexity. However, having the right diagnostic tools available to support these algorithms can enable precise pathogen identification and guide appropriate treatment, ensuring the right drug, dosage, and duration are prescribed for each patient.
Access to rapid and accurate diagnoses is essential in both inpatient and outpatient settings, where timely treatment decisions are critical to minimizing complications. Unfortunately, traditional bacterial culture and sensitivity testing methods present limitations in achieving timely, accurate differentiation of pathogens.
PCR testing, the predominant molecular diagnostic technology, has advanced through innovations like multiplex panels and point-of-care (POC) instruments. The enhanced efficiency, precision, and versatility of today’s PCR diagnostic platforms have empowered healthcare professionals to make more informed decisions about antibiotic use.
Leveraging molecular diagnostics to fight AMR across care settings
As part of a thoughtful testing algorithm, it is critical to differentiate viral pathogens, such as influenza, RSV, and SARS-CoV-2 for antiviral treatment, especially during seasonal surges of these infections. Molecular diagnostics can guide triage and treatment decisions in inpatient and outpatient settings alike.
For example, while culture-based methods are a standard approach to bacteriological diagnosis of lower respiratory tract infections, successful pathogen detection is achieved in only 20 percent to 40 percent of patients, contributing to longer hospital stays and unnecessary antibiotic use. Conversely, PCR-based panels enable faster, more sensitive and specific pathogen identification to inform targeted drug selection earlier in treatment.
Because up to 90 percent of human antibiotic use occurs in outpatient settings, implementing antibiotic stewardship efforts in doctor’s offices, urgent care centers, and other outpatient facilities is especially vital to fighting AMR. Nearly one-third of antibiotic prescriptions in these settings are unnecessary, further underscoring the need for molecular POC diagnostics.
Molecular POC tests empower providers to make accurate diagnoses quickly and prescribe antibiotics more judiciously than with symptom-based assessments alone. Advances in PCR-based diagnostics have enabled providers to test for multiple pathogens in a single multiplex assay and deliver results in 15 to 20 minutes, increasing these diagnostics’ applicability in POC settings, according to Roche Diagnostics. With user-friendly, benchtop solutions, innovative PCR testing platforms can overcome limitations in infrastructure and laboratory expertise to extend the benefits of these diagnostic tools to outpatient settings.
Investing in a healthier future
The fight against antimicrobial resistance requires a multi-faceted approach, with diagnostic and antibiotic stewardship at its core. Molecular diagnostic testing offers a powerful tool in this battle, enabling rapid, accurate, and specific diagnoses that guide appropriate antibiotic use.
Committing to comprehensive antimicrobial stewardship programs, coupled with robust testing algorithms and stronger testing infrastructure both in inpatient settings and at the point of care, can promote more responsible use of antibiotics and diagnostic testing. The value of appropriate antibiotic use extends far beyond cost and resource efficiency–it will be essential to preserve the efficacy of these vital drugs for future generations.