Antimicrobial resistance: Protecting our future by protecting our patients

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The coronavirus pandemic has demonstrated just how vulnerable the world’s population is to infectious disease risks and outbreaks. But while the COVID-19 threat will eventually subside, another pernicious global threat will remain. Antimicrobial resistance, or AMR for short, is among the most significant threats to the health and well-being of the world’s population now and for the foreseeable future. As the pathogens that cause infections become increasingly drug-resistant, common medical procedures – including surgery, childbirth and chemotherapy – will become increasingly life-threatening.

The urgent need for preserving existing antibiotics

The pipeline for new antibiotics is extremely limited. Pharmaceutical companies, insurers and even governments are all working to address this dire threat. But identifying, developing, and commercialising new drugs will take time. Therefore, it is essential to preserve the effectiveness of existing antimicrobial drugs for as long as possible. Unfortunately, many doctors focus on the pressing needs of the patient when making prescribing decisions, rather than broader public health considerations.

Antimicrobial stewardship programmes in health care settings are designed to optimise antibiotic therapies, with the intention of slowing the emergence of drug resistance, minimising adverse drug events and improving cure rates. During a webinar hosted by the Royal Society, I had the privilege of discussing some of the challenges hindering the appropriate use of antimicrobials.

Key components of successful antimicrobial stewardship programmes

Antimicrobial stewardship programmes are by design cross-functional as appropriate prescribing of antimicrobials requires a solid understanding of the patient, their symptoms, their medication history as well as any lab or test results that may have been ordered. While the role of the physician and pharmacist are often quickly understood, the role of the microbiology lab and data can be overlooked. Nevertheless, diagnostic testing is a critical part of any successful stewardship programme.

Accurate diagnostic testing can identify the infection-causing organism, determine whether it is resistant to particular treatment and guide the appropriate therapeutic choice¹. It will also underwrite a personalised care approach for each consumer. When integrated into antimicrobial stewardship programmes, rapid diagnostics have been shown to shorten time to optimal therapy, reducing complications, costs and mortality².

Increasing the speed of diagnostics is not just about how long the sample is in the lab, however. Rapid diagnostics must quickly and meaningfully communicate results to physicians so appropriate clinical decisions can be made, all of which may optimise the patient’s clinical outcome and personal experience.

Surveillance, reporting and collaboration are additional components of effective stewardship programmes. Coordinated collection, assimilation and analysis of data are necessary to track high-priority organisms and infections, provide early warning of infection outbreaks and support decision-making on antimicrobial stewardship across health care facilities³. Information systems that support and streamline surveillance data collection across health care facilities also enable more timely and automated reporting to regulatory agencies and authorities.

Lessons learned from the COVID-19 pandemic

As clearly demonstrated during the current coronavirus pandemic, access to accurate and rapid diagnostic testing alongside reliable public health data on the incidence and prevalence of disease are essential to contain and manage global health threats. And while it may be difficult to imagine, the threat of AMR will require even greater coordination, over a longer period of time. To stem the tide of rising resistance, we must act now.

While developing new antibiotics and other antimicrobials is necessary, we must leverage existing diagnostics to better assess and treat infections, today. We must also leverage the data and insights these tests provide to better understand how and where drug resistance is developing.

Successful strategies and initiatives that include collaborative partnerships will be important for improving stewardship, slowing the threat of antibiotic resistance, and strengthening outcomes.