Antimicrobial resistance
of antibiotics. The use of POCT is now proving to be highly beneficial, transforming the way that diagnostics are performed and delivering immediate results to enable informed clinical decision making for patients prior to antibiotic prescribing. The importance of the involvement of trained biomedical scientists in POCT implementation has also been highlighted in other recent POCT guidance.14
This guidance affirms that
diagnostic testing, regardless of setting, should remain within the expert domain of pathology departments. Thus, ensuring that high quality POCT is delivered within an accreditable framework.
POCT in AMR management New technologies have already enabled POCT with rapid results generation, meaning that tests can be carried out at the point when triage or treatment decisions are made. This approach is especially valuable in the context of differentiating between viral and bacterial infections, and therefore antibiotic prescriptions. For example, the presence of infection is often indicated by a range of factors such as abnormal body temperature, heart and respiration rate. However, these factors don’t indicate whether the infection is bacterial or viral in nature. C-reactive protein (CRP) is a widely used inflammatory biomarker which alongside haematology data can be used to help clinicians to effectively determine if an infection is viral or bacterial, the severity of the condition, and the most appropriate antimicrobial treatment (Figure 3). POC devices which combine Full Blood Counts (FBC) and a C-reactive protein (CRP) test, such as the Microsemi CRP haematology analyser (HORIBA), can give a rapid and accurate diagnosis at the point of treatment.
POC diagnostics in practice POC diagnostics are particularly important in paediatric departments as newborns and children are especially susceptible to bacterial infections due to their developing immune systems. When testing is performed, a CRP assay is commonly used in conjunction with
Antibiotic class Penicillins
Tetracyclines Macrolides Fluoroquinolones Carbapenems
Date of resistance identified
1940
Date of discovery
1928 1920 1930 1940
1953 1948 1950 1960 1970
1985 1985 1980 1990
1993
30 years since a new class of antibiotics was last introduced
2000
Fig 2. The timeline of antibiotic discovery and resistance since the early 1900s (Source: Health matters: antimicrobial resistance -
GOV.UK).
FBC. Traditionally, this test is performed in the hospital laboratory and, once received in the lab, results can take up to 60-90 minutes. The actual time from needle to result delivery can be much longer though. In a recent study, the John Radcliffe (JRH),
Stoke Mandeville (SMH) and Wexham Park (WPH) hospitals investigated whether the introduction of POCT for CRP and FBC, using the Microsemi CRP, could provide more rapid decision-making in a range of common paediatric conditions.15 The study found that using POCT as a
replacement for laboratory tests resulted in earlier decision-making in approximately 75% of cases across three hospital sites. Economic analysis across these sites found that this could result in net annual cost savings due to reduced staff time, as well as faster decisions on antibiotic use. Having recently won a Scientist’s Choice
Award in recognition of its rapid, safe, and easy diagnosis, the Yumizen H500 POC haematology analyser (HORIBA) was also highlighted within this study report as a suitable rapid near-patient testing tool.15,16
Capable of giving a FBC with a
five-part white blood cell (WBC) differential in just over one minute, this compact analyser is suitable for a range of settings including paediatric care, oncology units and drug monitoring services. Another study also demonstrated the
With POCT, unnecessary antibiotic usage can be minimised, ensuring that antibiotics are administered only when they are truly required. This not only helps reduce the development of antibiotic resistance but also ensures that patients are receiving the best care.
significant value of using POC diagnostics in a busy GP group practice.17
Using the Microsemi
CRP, the Brookside Group Practice (Lower Earley, Berkshire) aimed to relieve winter flu pressures and meet requirements to reduce unnecessary hospital visits and admissions. By using POCT, clinical staff experienced
increased confidence in their diagnoses, both by reinforcing initial assessments and providing clarity in cases of diagnostic uncertainty. Most notably, the use of POCT significantly impacted secondary care referrals, confirming decisions in 10% of cases and saving referrals in 19%. This investigation showed the value of POCT in primary care, increasing diagnostic confidence, enhancing clinical decision-making, improving the patient experience, and resulting in cost savings.17
Creating a better future Antimicrobials have been an essential tool in medicine for over a century, revolutionising our ability to combat infections and save countless lives. However, their excessive and inappropriate use over decades has led to the emergence of antimicrobial-resistant strains, making previously treatable infections increasingly difficult to manage. In light of this, it has become evident that we must reassess our approach to antibiotic use and prescriptions. To address this issue effectively, a multi-
faceted approach is essential. By implementing a ‘One Health’ strategy alongside the development of new drugs and the utilisation of POCT, we can start to control and contain the spread of AMR. By incorporating POCT into routine clinical practice, healthcare providers can identify the causative agent of an infection quickly and accurately, enabling evidence-based decisions regarding antibiotic prescriptions. With POCT, unnecessary antibiotic usage can be minimised, ensuring that antibiotics are
June 2024 I
www.clinicalservicesjournal.com 85 2010 2020
t
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56 |
Page 57 |
Page 58 |
Page 59 |
Page 60 |
Page 61 |
Page 62 |
Page 63 |
Page 64 |
Page 65 |
Page 66 |
Page 67 |
Page 68 |
Page 69 |
Page 70 |
Page 71 |
Page 72 |
Page 73 |
Page 74 |
Page 75 |
Page 76 |
Page 77 |
Page 78 |
Page 79 |
Page 80 |
Page 81 |
Page 82 |
Page 83 |
Page 84 |
Page 85 |
Page 86 |
Page 87 |
Page 88
