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How Labs Can Bolster Antimicrobial Stewardship

COVID-19 has emphasized the importance of rapid results from the laboratory

Anne Beall

Anne Beall, senior director, lab optimization consultancy expert of bioMerieux, Inc., applies expert knowledge, industry experience, and relentless energy to lead the transformation both clinical & industrial laboratories. As a clinical microbiologist & Lean Six Sigma Green Belt, she brings more than 29 years of laboratory operations and best practices experience to optimize customers’ laboratories. She has a comprehensive understanding of daily laboratory operations applying process improvement to solve problems and improve performance metrics.

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Published:Oct 22, 2020
|3 min read
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How microbiology labs help clinicians combat infections and antimicrobial resistance

Antimicrobial resistance (AMR) is a great threat to the health and well-being of humankind. In 2019, the U.S. Centers for Disease Control and Prevention estimated that 2.8 million patients annually are affected by resistant pathogens leading to more than 35,000 deaths. According to the 2016 AMR review, if trends continue, AMR will be a greater cause of mortality than heart disease or cancer by 2050. These facts, coupled with the crisis of the novel coronavirus (COVID-19), have highlighted our extraordinary battle against infectious diseases, and our greater-than-ever need for antimicrobial stewardship in the medical community. One of the best ways for health care systems to bolster their antimicrobial stewardship efforts is to closely partner with microbiology labs. These labs can provide rapid diagnostics as well as fast antimicrobial susceptibility test (AST) results. When combined with focused stewardship efforts, education, and real-time data, hospitals can combat antimicrobial resistance and deliver better patient outcomes.

Getting faster AST results from the microbiology lab 

Microbiology is the basis for the detection of multi-drug-resistant organisms and the impetus that prompts infection control action. Understanding whether or not a patient already has a drug-resistant infection prior to antibiotic selection is key to determining the best initial course of treatment. Microbiology labs have access to technology that provides AST results in an average of nine hours from bacterial colony growth, as well as direct from sample tests that are capable of delivering results from blood, cerebrospinal fluid, stool, and respiratory samples in hours rather than days. Because of the technology available today, microbiology labs need to be reading cultures 24/7 to provide these valuable results to clinicians. A stronger partnership with the microbiology lab is an essential strategy to combat AMR.

Additionally, microbiology labs can help change the habits of providers using frontline broad-spectrum antibiotics as a catchall solution. Selective and timely communication of diagnostics and AST results directly impacts prescribing and helps clinicians optimize antibiotic therapy. For antibiotic optimization to work efficiently, the laboratory analytical process needs to be predictable. What turnaround-time (TAT) can the microbiology laboratory provide for fast and actionable diagnostics and AST results? Are they accountable for providing that TAT? If patients are to receive the same level of care 24/7, we must demand 24/7 coverage for microbiology. Education, sustainable AST TAT, and rapid diagnostic tests can all be part of the strategy to combat AMR. Strengthening the microbiology laboratory and clinician partnership will go a long way to create much needed momentum for diagnostic stewardship.   

Tracking antimicrobial susceptibility in patients

In the United States, infections caused by multidrug resistant organisms rack up healthcare costs of over $20 billion per year, due to the need for additional hospitalizations. As such, being able to track which patients may have a predisposition toward antibiotic resistance will not only save money, but also save countless lives. Fostering strong relationships between microbiology labs and clinicians can help track antimicrobial susceptibility in the following ways:

  • Labs can provide historical or predictive AST reports before the healthcare provider prescribes antibiotics.
  • Labs can flag active detection of viral pathogens in patients’ samples.
  • Labs can advise clinicians to avoid collecting specimens from body sites associated with microbial colonization.

Using cloud-based technology for immediate data access

When it comes to fighting antibiotic resistance, access to rapid and reliable testing data at a single hospital is great, but access to unified testing data from around the world is even better. Cloud-based software can help provide that on-demand, comprehensive view of testing data by giving health care providers access to global databases with pathogen and antibiotic-resistant gene information collected from hospitals, clinics and facilities around the world.

Individual samples and test results can be analyzed against previously collected records to find similarities in pathogen strains or identify drug-resistant genes. This immediate access to pathogen data and outcomes can help clinicians make more confident treatment decisions. Overall, cloud-based data platforms are a powerful tool in antimicrobial stewardship related to fighting AMR, yet prior to 2020 these tools were still vastly under implemented. COVID-19 has greatly accelerated the uptake of cloud-based solutions for microbiology labs. The opportunity to expand the focus of these connections to aid in the fight against AMR must not be squandered. With these platforms and other lab-based solutions, practitioners can identify highly infectious, antibiotic-resistant pathogens in individual patients in real-time, and improve infection-control practices to safeguard against future outbreaks.