MOLECULAR DIAGNOSTICS :: ANTIMICROBIAL RESISTANCE
Molecular diagnostics in treating lower respiratory tract infections with consideration for antimicrobial resistance
By Faranak Atrzadeh D
espite global focus on the COVID-19 pandemic, the concern around antimicrobial resistance (AMR) has con- tinued to grow, albeit a bit further in the background. In
2019, AMR was the direct cause of at least 1.27 million deaths (See Figure 1). When stepping back to consider global deaths associated with AMR, that number increased to 4.95 million.1 COVID-19 has only exacerbated existing concerns. Earlier this year, the Centers for Disease Control and Prevention (CDC) reported that drug-resistant infections in hospitalized patients rose by 15% from 2019 to 2020,2
confirming the fears of many
frontline workers and epidemiologists that COVID-19 admis- sions resulted in over-prescription. In order to combat this growing threat, the global healthcare community is researching a number of both drug-based and non-drug-based solutions. Drug-based approaches pose a number of immediate and long-term challenges. The World Health Organization’s (WHO) report titled “2021 Antibacterial agents in clinical and preclinical development: an overview and analysis” characterizes the current number of antibacte- rial drugs in preclinical and clinical development as stagnant and far from meeting global needs.3
Further, the same WHO
analysis showed that in 2021 there were only 27 new antibiotics in clinical development against priority pathogens, compared to 31 products in 2017.
22 DECEMBER 2022
MLO-ONLINE.COM
Lower respiratory tract infections and AMR Lower respiratory tract infections (LRTIs) such as pneumonia pose a particular threat to antimicrobial resistance for a number of reasons. First, these infections are highly prevalent in global populations. In 2015, it was estimated that LRTIs caused 2.74 million deaths worldwide.4
High rates of antimicrobial resis-
tance have been observed for the pathogens responsible for LRTIs.5
In a 2021 study, researchers processed a total of 7,038 samples of sputum and bronchial aspirate according to the standard microbiological methods. In these samples a “very high rate of resistance” (98–100%) was observed among Aci- netobacter baumannii isolates to Amoxicillin/Clavulanic acid, Cefotaxime, Ciprofloxacin, Ertapenem, Gentamicin, Imipenem, and Trimethoprim/Sulfamethoxazole.5 Where COVID-19 has already exacerbated concerns around AMR more generally,2
particularly in its earlier mutations, only adds to the types of respiratory symptoms being treated with inappropriate anti- biotics. The high rates of antimicrobial resistance are not really surprising due to how similarly many LRTIs present and the common approach of prescribing broad spectrum antibiotics. Pneumonia, one of many LRTIs raising concerns, is among the most common reasons for inpatient antibiotic use and overuse.6 Hospital-associated pneumonia (HAP) accounts for 22% of all
the virus’ targeting of the respiratory tract,
Photo by
designer491@bigstockphoto.com
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