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2. Murray, Christopher J L et al. Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis. The Lancet, Volume 399, Issue 10325, 629 – 655. Accessed at: https://
www.thelancet.com/journals/lancet/article/ PIIS0140-6736(21)02724-0
3. UK 20-year vision for antimicrobial resistance, Department of Health and Social Care, 24 January 2019.
https://www.gov.uk/ government/publications/uk-20-year-vision- for-antimicrobial-resistance
4. UK 5-year action plan for antimicrobial resistance 2019 to 2024, Department of Health and Social Care, 24 January 2019. https://
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5. Confronting antimicrobial resistance 2024 to 2029, May 2024. HM Government. Accessed at:
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6. Political Declaration of the High-level Meeting on Antimicrobial Resistance, 9 September 2024.
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7. WHO, 26 September 2024 UN General Assembly High-Level Meeting on antimicrobial resistance 2024.
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www.clinicalservicesjournal.com I November 2024 COMMENT with SUSANNE EMMERICH
Calls for POC testing to tackle AMR
Susanne Emmerich, Associate Director Medical Affairs, Rapid Diagnostics, at Abbott, discusses the case for diagnostic testing in the fight against AMR Antimicrobial resistance (AMR) — the ability of microbes to resist antimicrobial agents,
rendering the most treatable conditions and illnesses untreatable — is among the most pressing public health challenges facing the global community today. In the UK, AMR is identified as a chronic risk in the National Risk Register alongside artificial intelligence, climate change and serious organised crime. An estimated 58,224 people in England had an antibiotic resistant infection in 2022 – an increase of 4% since 2021. This corresponded with an increase in deaths - by nearly 100 - due to severe antibiotic resistant infections. The threat of AMR is well understood by doctors, nurses, pharmacists, and the
Government, with the second five-year national action plan setting out the importance of investing in innovation and calling on the life sciences sector to prioritise the development of new approaches to diagnose and treat infections. Ensuring healthcare professionals have access to rapid point of care testing (POCT) tools to use alongside the clinical evaluation of patient signs and symptoms, can ensure that antibiotics are prescribed responsibly, helping to address the issues caused by AMR. In Switzerland, Norway, and the Netherlands, GPs regularly perform C-reactive protein
(CRP) POCT, which is a proven and available tool recommended by the Organisation for Economic Co-operation and Development (OECD) and the World Health Organization (WHO). However, other than during the COVID pandemic, implementation of these tools within the NHS hasn’t progressed much since the UK’s first five-year action plan for antimicrobial resistance (2019 to 2024). The latest iteration of the plan again references the role diagnostics can play. However, to see any tangible outcomes, accelerating access to rapid POCT by encouraging their use in primary, community and secondary care settings, should be viewed as a priority. In a pilot project, we worked closely with Townsend, Axminster, and Seaton & Colyton Primary
Care Network (PCN) in Devon to implement POCT using Abbott’s ID NOW STREP A 2 platform,1 for patients presenting with an acute sore throat suspected to be Streptococcus A. The test was used alongside routine clinical assessment, and results showed that over a three-month period, there was a 55–65% reduction in immediate and deferred antibiotic prescriptions.2 The study also involved Seaton Pharmacy, which highlighted that testing in pharmacies could provide extra capacity for treatment. With increased community access to antibiotics through the Pharmacy First model, accurate diagnosis at pharmacy level is also vital in tackling AMR. It is always important to recognise some of the challenges at play when assessing strategies. In particular, prescribing an antibiotic is always likely to be cheaper than a diagnostic test.3 However, CRP POCT is a proven tool to support the prescribing decision of the doctor, leading to a reduction in antibiotic prescribing. POCT can help clinicians evaluate the probability of the need for antibiotics in a few minutes, whereas tests usually performed in laboratories traditionally take 48–72 hours to be helpful for immediate prescription. What is clear is that POCT can support clinical evaluation and enable healthcare
professionals to feel confident in prescribing antibiotics responsibly, helping to address some of the issues caused by AMR. Publication of a transparent plan by NHS England as to how it will take forward the recommendations in the National Action Plan would be valuable to all stakeholders, along with a conscious effort to place diagnostics at community level on par with therapeutics to support the fight against AMR.
References 1.
https://www.globalpointofcare.abbott/us/en/product-details/id-now-strep-a-2.html 2.
https://www.mdpi.com/2075-4418/14/11/1104#:~:text=The%20addition%20of%20rapid%20 molecular,and%20a%20longer%20appointment%20length
3.
https://publications.parliament.uk/pa/cm201719/cmselect/cmhealth/962/962.pdf
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