Antimicrobial resistance (AMR) poses a significant threat to global public health—and this threat is only growing. We’re here to explain what AMR is, why it matters, and the important role that diagnostic solutions play in helping to promote antibiotic stewardship.
Antibiotic resistance. Multi-drug resistance. Drug resistant infections. Multi-resistant organisms. These are all terms that encapsulate a single phenomenon, one that has been labeled by the World Health Organization as one of the biggest threats to public health this century.
Antimicrobial resistance occurs when microbes—including bacteria, viruses, and fungi—no longer respond to the drugs designed to target them. These drugs, called antimicrobials, are typically prescribed to battle infections such as strep throat and sepsis. When drug resistance develops, it doesn’t mean something is wrong with how the human body responds to infection or medication. Rather, it is the pathogens themselves that undergo changes that lead them to developing resistance mechanisms—or acquiring them from other pathogens—to ensure their survival.
The more frequently bacteria and fungi are exposed to antimicrobials, the more opportunities they have to develop or acquire resistance to them.
Over time, this process can make medications less effective in fighting infections. It can even lead to the emergence of dangerous superbugs that are resistant to many different types of antimicrobials and make infections hard to treat, such as methicillin-resistant Staphylococcus aureus or drug-resistant Candida spp.
When talking about antimicrobial resistance, the discourse generally refers to drug-resistant bacteria (i.e., antibiotic resistance). However, it is important to note that the term “antimicrobial” encompasses a wider group of medications that includes antivirals, antifungals, as well as antibiotics. Given that fungi—such as Candida auris—have also become urgent antimicrobial resistance threats, differentiating antimicrobial from antibiotic resistance is becoming increasingly relevant.1
Antimicrobial resistance can develop quickly, especially when mutating bacteria and fungi are exposed to antimicrobials that are prescribed excessively or unnecessarily. This can be seen not just in the healthcare space but also in connection to the use of antifungals and antibiotics in agriculture and livestock, respectively.
AMR can also make diagnosing and properly treating deadly infections like sepsis more difficult. Making matters more difficult are those pathogens that are naturally resistant to certain medications without having to undergo any changes. That’s why prescribing the right drug depends on identifying the pathogen that caused the infection.
Antimicrobial resistance also occurs over time by new genetic mutation or by horizontal gene transfer. Genetic mutation occurs when bacterial DNA changes, or mutates, to help the bacteria and fungi survive antimicrobial treatment. When mutated pathogens reproduce and outlive the original bacteria, AMR spreads. Horizontal gene transfer is what happens when pathogens acquire genetic mutations from other pathogens.
Antimicrobial stewardship (AMS) programs are efforts to combat antimicrobial resistance by optimizing the use of antimicrobial medications, including antibiotics. Antibiotics and other antimicrobials are vital and lifesaving, but it is their use—especially overuse and misuse—that contributes most to antimicrobial resistance.2
Antimicrobial stewardship programs aim to reduce the number of unnecessary and inappropriate antimicrobial prescriptions to improve patient outcomes and curb resistance. Because these programs can play a key role in helping prevent and curb disease outbreaks, AMS should be central to every institution’s emergency preparedness efforts. Ideally, antimicrobial stewardship includes all departments and touchpoints of the health care system.
Diagnostics are key to antimicrobial stewardship efforts because diagnostic answers enable clinicians to target therapy to the causative pathogen. Diagnostic stewardship encapsulates the combined efforts of healthcare teams to improve the overall process of diagnosing patients. These efforts begin with determining and implementing the most effective ways to diagnose patients so they can be appropriately treated.
Antimicrobial stewardship is not something that can happen overnight or by a singular action; it is a continuous effort that occurs throughout the patient journey. From sample collection to antibiotic discontinuation, effective AMS comes when health care providers leverage diagnostic products and solutions that:
The diverse portfolio developed by bioMérieux covers all the above points to create an end-to-end AMR solution (see Figure A). The first step involves procalcitonin (PCT) and syndromic testing to rapidly diagnose and gauge the severity of the illness. Then, our ID/AST solutions scrutinize the results further to help clinicians determine the appropriate antimicrobial treatment. The final step involves follow-up PCT testing that informs the subsequent discontinuation of antimicrobials.
Figure A: Integrated AMR Solutions from bioMérieux*
The best thing to do about antimicrobial resistance is to be aware and be informed. bioMérieux is committed to helping health care professionals do just that through our dedicated portal, where anyone can learn about our global antimicrobial stewardship efforts and innovations in infectious disease diagnostics.
The next best step in tackling drug resistant infections is equipping hospitals and labs with diagnostic solutions that offer fast and accurate results that inform optimal patient care. When it comes to infectious diseases—especially serious conditions such as bacterial meningitis or sepsis—every second counts. Interim treatment in the form of broad-spectrum antibiotics may sometimes be the best short-term solution, but long-term, the drugs could potentially impede recovery, worsen the underlying condition, and cause multi-drug resistance.
At bioMérieux, AMR is always front of mind, and we strive to develop diagnostic solutions that address this growing trend. The BIOFIRE syndromic panels are state-of-the-art multiplex PCR tests that require only a few minutes of hands-on time and deliver results on numerous probable bacterial, viral, fungal, and antimicrobial resistance gene targets in as little as ~1 hour. Meanwhile, our portfolio of integrated AMR solutions includes a range of microbiology, mass spectrometry, immunoassay, and other technologies that are designed to detect the causes of antibiotic resistance and provide actionable results that inform antimicrobial therapy.
*Product availability varies by country. Consult your bioMérieux representative.
References:
Diagnostics are the Heart of Antimicrobial Stewardship
