Antimicrobial resistance: Difference between revisions

[[Antibiotic sensitivity|Antimicrobial susceptibility testing]] (AST) can facilitate a [[precision medicine]] approach to treatment by helping clinicians to prescribe more effective and targeted antimicrobial therapy.<ref>{{cite news |date=20 November 2018 |title=Diagnostics Are Helping Counter Antimicrobial Resistance, But More Work Is Needed |work=MDDI Online |url=https://www.mddionline.com/diagnostics-are-helping-counter-antimicrobial-resistance-more-work-needed |access-date=2 December 2018 |archive-date=2 December 2018 |archive-url=https://web.archive.org/web/20181202202615/https://www.mddionline.com/diagnostics-are-helping-counter-antimicrobial-resistance-more-work-needed |url-status=dead }}</ref> At the same time with traditional phenotypic AST it can take 12 to 48 hours to obtain a result due to the time taken for organisms to grow on/in culture media.<ref name=":6">{{cite journal |display-authors=6 |vauthors=van Belkum A, Bachmann TT, Lüdke G, Lisby JG, Kahlmeter G, Mohess A, Becker K, Hays JP, Woodford N, Mitsakakis K, Moran-Gilad J, Vila J, Peter H, Rex JH, Dunne WM |date=January 2019 |title=Developmental roadmap for antimicrobial susceptibility testing systems |journal=Nature Reviews. Microbiology |volume=17 |issue=1 |pages=51–62 |doi=10.1038/s41579-018-0098-9 |pmc=7138758 |pmid=30333569 |doi-access=free |hdl=2445/132505}}</ref> Rapid testing, possible from [[molecular diagnostics]] innovations, is defined as "being feasible within an 8-h working shift".<ref name=":6" /> There are several commercial Food and Drug Administration-approved assays available which can detect AMR genes from a variety of specimen types. Progress has been slow due to a range of reasons including cost and regulation.<ref>{{cite journal |vauthors= |date=October 2018 |title=Progress on antibiotic resistance |journal=Nature |volume=562 |issue=7727 |pages=307 |bibcode=2018Natur.562Q.307. |doi=10.1038/d41586-018-07031-7 |pmid=30333595 |doi-access=free}}</ref> Genotypic AMR characterisation methods are, however, being increasingly used in combination with machine learning algorithms in research to help better predict phenotypic AMR from organism genotype.<ref>{{cite journal |display-authors=6 |vauthors=Kim JI, Maguire F, Tsang KK, Gouliouris T, Peacock SJ, McAllister TA, McArthur AG, Beiko RG |date=September 2022 |title=Machine Learning for Antimicrobial Resistance Prediction: Current Practice, Limitations, and Clinical Perspective |journal=Clinical Microbiology Reviews |volume=35 |issue=3 |pages=e0017921 |doi=10.1128/cmr.00179-21 |pmc=9491192 |pmid=35612324 }}</ref><ref>{{cite journal |vauthors=Banerjee R, Patel R |date=February 2023 |title=Molecular diagnostics for genotypic detection of antibiotic resistance: current landscape and future directions |journal=JAC-antimicrobial Resistance |volume=5 |issue=1 |pages=dlad018 |doi=10.1093/jacamr/dlad018 |pmc=9937039 |pmid=36816746}}</ref>

 

 

Rapid diagnostic methods have also been trialled as antimicrobial stewardship interventions to influence the healthcare drivers of AMR. Serum [[procalcitonin]] measurement has been shown to reduce mortality rate, antimicrobial consumption and antimicrobial-related side-effects in patients with respiratory infections, but impact on AMR has not yet been demonstrated.<ref>{{cite journal |display-authors=6 |vauthors=Schuetz P, Wirz Y, Sager R, Christ-Crain M, Stolz D, Tamm M, Bouadma L, Luyt CE, Wolff M, Chastre J, Tubach F, Kristoffersen KB, Burkhardt O, Welte T, Schroeder S, Nobre V, Wei L, Bucher HC, Bhatnagar N, Annane D, Reinhart K, Branche A, Damas P, Nijsten M, de Lange DW, Deliberato RO, Lima SS, Maravić-Stojković V, Verduri A, Cao B, Shehabi Y, Beishuizen A, Jensen JS, Corti C, Van Oers JA, Falsey AR, de Jong E, Oliveira CF, Beghe B, Briel M, Mueller B |date=October 2017 |title=Procalcitonin to initiate or discontinue antibiotics in acute respiratory tract infections |journal=The Cochrane Database of Systematic Reviews |volume=10 |issue=10 |pages=CD007498 |doi=10.1002/14651858.CD007498.pub3 |pmc=6485408 |pmid=29025194 |collaboration=Cochrane Acute Respiratory Infections Group}}</ref> Similarly, point of care serum testing of the inflammatory biomarker [[C-reactive protein]] has been shown to influence antimicrobial prescribing rates in this patient cohort, but further research is required to demonstrate an effect on rates of AMR.<ref>{{cite journal |vauthors=Smedemark SA, Aabenhus R, Llor C, Fournaise A, Olsen O, Jørgensen KJ |date=October 2022 |title=Biomarkers as point-of-care tests to guide prescription of antibiotics in people with acute respiratory infections in primary care |journal=The Cochrane Database of Systematic Reviews |volume=2022 |issue=10 |pages=CD010130 |doi=10.1002/14651858.CD010130.pub3 |pmc=9575154 |pmid=36250577 |collaboration=Cochrane Acute Respiratory Infections Group}}</ref> Clinical investigation to rule out bacterial infections are often done for patients with pediatric acute respiratory infections. Currently it is unclear if rapid viral testing affects antibiotic use in children.<ref>{{cite journal |vauthors=Doan Q, Enarson P, Kissoon N, Klassen TP, Johnson DW |date=September 2014 |title=Rapid viral diagnosis for acute febrile respiratory illness in children in the Emergency Department |journal=The Cochrane Database of Systematic Reviews |volume=9 |issue=9 |pages=CD006452 |doi=10.1002/14651858.CD006452.pub4 |pmc=6718218 |pmid=25222468}}</ref>