A few years ago I was attending a conference on biologics manufacturing and the keynote speaker said their industry was lagging in implementing modern microbiological tools whereas the beer industry was way ahead. I was glad there were no clinical microbiologists in the room!
Molecular methods have been used for the discovery of several pathogens in the past decade and a number of case studies have been published on the ability of these methods to identify pathogens where culture fails. Despite these advances, rapid amplification and detection technologies have been slow to get into routine diagnostics for patient care, especially in bacteriology and mycology.
What is the impact? Every year more than eight million people around the world are diagnosed with sepsis; more than six million are hospitalized for pneumonia; and about 160,000 immunocompromised patients are hospitalized with infections.[1] Studies have shown that routine culture-based identification misses over 50 percent of cases where a bacterial cause of infection should have been detected. Would molecular methods solve this problem entirely? Perhaps not. But it would definitely add to the tool chest at the disposal of the clinician and perhaps point to right direction earlier.
Earlier identification is the key to better patient management. Current guidelines for sepsis treatment recommend antibiotic treatment for sepsis patients upon admission, prior to any diagnostic result. However, under the current diagnostic standards, which may take several days for definitive answers, several rounds of antibiotics may be administered before identity of the organisms is known, leading to the potential problem of drug-resistant “superbugs.” Despite understanding the long-term risks of resistance, doctors are focused almost exclusively on treating the potential infection in front of them in their individual patient. Often times, they must play a guessing game to avoid wasting precious time. Who can blame them?
Resistant superbugs and poor use of antibiotics are together leading us toward an “antimicrobial perfect storm” in the next few decades. This may sound apocalyptic, but it is simple epidemiology: increasing resistance combined with decreasing antibiotic options will worsen to the point where we will have no capacity to treat previously highly treatable infections.
The question becomes: what can be done to help doctors diagnose patients faster and reduce over-prescribing antibiotics? The first logical step is to rapidly adopt improved diagnostic technology. There are several newer technologies on the horizon and getting them into routine care should be a priority. For example, as a part of Abbott, I have been involved in developing a DNA-based technology, known as IRIDICA, that is being designed to extract the pathogen DNA from a patient sample and test it for a broad range of pathogens. Promising preliminary data suggests this platform is comparable to current standard of care, but produces results much more quickly. Further, there is indirect evidence that several of the cases that were missed by culture, but positive by this method, may in fact be relevant.[2] Wide adoption of new types of diagnostic technology could translate into improved patient care and treatment, and help drive significant cost savings for health systems.
A drug-resistant future can be prevented – if the right diagnostic tools become part of standard practice. Just as we can’t imagine relying on a clunky typewriter for our daily computing needs of today, I imagine years from now we may realize that our previous technology for diagnosing infections was outdated.
– By Rangarajan Sampath, PhD, Director of Science & Technology, Ibis Biosciences, Abbott
[1]World Sepsis Day, Sepsis Facts, Dellinger et al. Crit Care Med 2013;41:580–637
[2] Salvage Microbiology: Farrell et. al. PLoS One 8:e66349. doi:66310.61371/journal.pone.0066349
Editor’s Note: This post is part 1 of a 4-part series on Superbugs. It gives a Company View on the Superbugs discussion. Check out the Foundation View, Industry View and Physician View in the Superbug series.
