A process-driven approach can avoid the need for practitioners to prescribe antibiotics

By: Dr. Suleiman Al- Obeid 
MD. PhD consultant clinical microbiology Head of microbiology division, security Forces Hospital, Riyadh Saudi Arabia

Dubai, UAE, September 19, 2016:   Multidrug resistant bacteria are an increasing concern. Several bugs have become dangerously resistant  to common antibiotics, making it harder for the medical community to contain infections after even routine operations. Antimicrobial resistance affects patient care on both an individual level and on a collective level. For example, in the case of infectious diseases the doctor will be forced to choose a larger empiric antimicrobial chemotherapy which might be more toxic, more expensive and harder to use than first line agents. On a collective level, the increasing resistance becomes a vicious cycle that promotes repeated use of broad-spectrum therapy and promoting the same resistant strains for subsequent episodes. 

The decreasing effectiveness of antibiotics in treating common infections has quickened in recent years, and with the arrival of untreatable strains of carbapenem resistant Enterobacteriacea, we are at the dawn of a post antibiotic era. In high-income countries, continued high rates of antibiotic use in hospitals, the community, and agriculture have contributed to the selection of pressure that has sustained resistant strains, therefore forcing a shift to more expensive and more broad-spectrum antibiotics.

Doctors in the UAE suggest that overuse  of antibiotics can make bacteria resistant to them and contributes to the evolution of “superbugs”. They call for implementing restricted regulations on over-the-counter antibiotic sales and in raising consumer awareness to reduce patient demand for antibiotics. Antibiotic resistance is of course not attributed to this alone. 

Even before penicillin was introduced, resistant strains of bacteria had been detected. The selection pressure caused by the use of millions of tons of antibiotics over the past 75 years since antibiotics were introduced, has made almost all disease-causing bacteria resistant to antibiotics commonly used to treat them. The rapid evolution of bacterial resistance is clear in the case of β-lactamases class of antibiotics. Nearly 1000 resistance-related β-lactamases that inactivate these antibiotics have been identified, a ten times increase since before 1990.

Researchers also suggest that poor hand-hygiene compliance has contributed to the spread of antibiotic-resistant bacteria. For example, it is due to this reason that health authorities recommend that those travelling to Saudi Arabia for Hajj, where millions of people from around the world congregate, should consult their physician beforehand to check their health and reduce risks of infection- rather than having to be treated with antibiotics later.

Implementation of basic hygienic routines is still largely absent in many hospitals and healthcare settings worldwide. Cultural and other barriers for their implementation need much more study. Infection control interventions need to be reassessed and improved in an era with rapid transmission of multidrug-resistant bacteria and mobile antibiotic resistance genes.

As innovation in antibiotics becomes rarer, to face these resistant bacteria strains the market needs to be supported by antimicrobial susceptibility tools that not only provide robust results but also fast-track therapy optimization. The healthcare system needs to optimize the use of current compounds and curb proliferation of antibiotics being handed out without prescriptions.

For the system to work, all healthcare professionals need to ensure they keep accurate, timely and clear medical records. Inaccuracies or improper record keeping may have devastating consequences to the patient and all concerned in the care of the patient. Effective clinical practice must not focus only on technological system issues, but also on the human factor. Good communication encourages collaboration and helps prevent errors. It is important for healthcare organizations to assess possible setups for poor communication and be diligent about offering programs and outlets to help foster team collaboration. By addressing this issue, health care organizations have an opportunity to greatly enhance their clinical outcomes.

Role of diagnostics

Generally, efforts to improve microbiological laboratories are underway. Speed of testing and laboratory automation has been the focus of recent developments. In trying to reduce testing time, various methods have been developed (eg, PCR-based tests, various point-of-care tests, and MALDI-TOF mass spectrometry). These tests are supplementary to detect disease causing pathogens next to traditional culture-based methods because they detect only the pathogens for which the test is designed. Diagnostic methods that reduce antibiotic use or narrow the spectrum should be promoted. Even if these methods do not have a direct benefit on clinical outcome, reduction of antibiotic pressure can help to slow induction and spread of resistance.

Restriction of antibiotic consumption to below predefined total use thresholds might remove the selection pressure that maintains antimicrobial resistance within populations. We assessed the effect of national antibiotic stewardship and infection prevention and control programs on the prevalence density of multidrug-resistant organisms across a specific region.

In order to slow the emergence and prevent the spread of resistant bacteria and strengthen national and international efforts to identify and report cases of antibiotic resistance, there needs to be adequate technology backing, e.g. a solution that automates and integrates all steps in the microbiology laboratory to improve productivity, streamline workflow and provide accurate results for the clinician to deliver better patient care -  can help practitioners focus better and save valuable time and resources. It is not just technology, but the entire system needs to have in place processes, tools, education, and programs designed to increase staff competency, efficiency and productivity. 

To that extent, the MicroScan WalkAway plus System provides high-quality performance and reliability for automated identification (ID) and antibiotic susceptibility testing (AST). This customizable solution is adaptable and scalable to meet varying laboratory needs and is backed by 30 years of ID/AST testing experience. 

Through MicroScan technology, a microbiologist can easily control the growth of bacteria. The disk diffusion method is a very visual approach of AST that Microscan automates effortlessly. 

Advanced Minimum Inhibitory Concentration (MIC) technology detects emerging resistance as it occurs, providing accurate results without reliance on historical data or virtual MIC. The technology unearths data and also interprets them, enabling microbiologists and physicians to optimize their antimicrobial strategies, resulting in fewer repeat and confirmatory tests. Technology is increasingly enabling healthcare practitioners to get answers right the first time.