Innovation

The role of diagnostic testing in an era of antimicrobial stewardship

Facing the growing threat of drug-resistant bacteria

As mankind continues its widespread use of antibiotics, antimicrobial resistance will continue to pose a threat to the global healthcare system.

As new antibiotics are developed and used widely around the world, bacteria evolve in parallel, developing resistance and outrunning our ability to treat common infections. Infections caused by antibiotic-resistant bacteria are difficult to treat, killing an estimated 700,000 people a year worldwide.1

The world learned of the dangers of antimicrobial resistance with the rise of hospital-acquired infections, like methicillin-resistant Staphylococcus aureus (MRSA). Today, there are a growing number of infectious diseases developing resistance to common treatments, including certain respiratory tract infections and sexually transmitted infections. Looking ahead, the prevalence of drug-resistant pathogens is expected to rise.

In the absence of a comprehensive effort to combat emerging drug resistance, infections with multi-drug resistant organisms are predicted to be the leading cause of death worldwide by 2050.1

Eliminating unnecessary antibiotic use

Empirical diagnoses cannot reliably differentiate bacterial agents, nor discriminate between bacteria, viruses and fungi.

The inability to empirically diagnose the exact pathogen causing an infection often leads to broad-spectrum or unnecessary antibiotic prescribing. This adds unnecessary cost and promotes the development of antibiotic resistance.2 In the U.S., one in three outpatient antibiotic prescriptions are inappropriate.3 Eliminating unnecessary use of antibiotics is essential for preventing the emergence of drug-resistant bacteria, and a key strategy to countering this troubling trend is the consistent and proper use of diagnostic tests.

The traditional “gold-standard” detection technique of culture requires time for the organism to grow—delaying time to result—and needs the skills of a highly trained technician.. Today, high-quality molecular testing systems have fast turnaround times and a fully automated workflow to streamline the detection and differentiation of select viral and bacterial agents. The efficiency and throughput of these systems present laboratories with an opportunity to elevate, in part, the value they deliver across the healthcare system. Reducing pressure during spikes in demand enables labs to inform timely, appropriate management decisions.

Transforming testing and treatment with innovation and ingenuity

To combat an ever-evolving threat of antibiotic resistance, health systems will need to adopt different strategies to cover a range of scenarios.

Recent advances in testing are accelerating the way resistant pathogens are detected compared to traditional methods. Identifying sequences linked to genotypic resistance detection and rapid phenotypic resistance detection enable laboratories to play a greater role in protecting the population from resistant pathogens. However, this is not a battle that will be won in the laboratory alone.

Each year, there are millions of unnecessary antibiotic prescriptions written in doctors’ offices and emergency departments,4 highlighting the need for advanced point-of-care (POC) testing solutions. Molecular POC tests are important tools that can bring an accurate diagnosis quickly, enabling the opportunity for faster treatment. Timely and reliable results empower physicians to prescribe more judiciously and employ antibiotic stewardship principles where they can have a notable impact.

Addressing the threat of resistant bacteria

As a leader in diagnostics, Roche is committed to providing effective integrated solutions that can inform optimal patient care.

Through continuous monitoring of the global disease landscape, Roche works to identify strategies to combat and control the spread of resistant pathogens. Roche’s innovative technologies allow laboratories to detect drug-resistant bacteria with the speed and simplicity of molecular diagnostics, and provide accurate and actionable results closer to the patient with minimal turnaround times.

Roche is expanding their commitment to antibiotic stewardship through collaboration and innovation—from joining the AMR Action Fund to investing heavily into assays and analyzers that inform effective treatment decisions. Roche tests are trusted to deliver confidence in every result, anywhere, using fully automated high-throughput systems and on-demand testing at the point of care.

As the threat of antimicrobial resistance continues to grow, Roche will be a perennial partner to global health systems, providing world-class solutions to this worldwide challenge.

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infectious diseases on the
laboratory landscape

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Detect mutations associated with resistance to antibiotics rifampicin and isoniazid within tuberculosis DNA, as part of a complete mycobacteria testing algorithm.

 

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Offering a turnaround times of 20 minutes or less, this fast, flexible, secure solution requires minimal training, making it ideal for situations requiring a rapid diagnosis and treatment decision.

 

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Automated multiplex real-time RT-PCR assay that detects and differentiates both influenza A and influenza B in ~20 minutes.

Influenza A/B and RSV molecular point-of-care test

Automated multiplex real-time RT-PCR assay for the rapid in vitro qualitative detection and discrimination of influenza A virus, influenza B virus and respiratory syncytial virus (RSV) RNA in 20 minutes.

 

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Strep A molecular point-of-care test

Automated real-time PCR test for the detection of Strep A in patients with signs and symptoms of pharyngitis, delivering results in ~15 minutes.

Mycoplasma genitalium resistance test

Simultaneously detect Mycoplasma genitalium and 5 mutations at positions 2058 and 2059 in the 23S rRNA gene (E. coli numbering) that are associated with resistance to azithromycin (macrolide-based antibiotic).

 

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Neisseria gonorrhea resistance test

Simultaneously detect the bacterium Neisseria gonorrhoeae (GC) and the gyrA S91 (wild type) or gyrA S91F (mutant) markers that are associated with susceptibility or resistance to the fluoroquinolone antibiotic, ciprofloxacin.

 

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Rapid phenotypic resistance detection

Discover a new class of molecular diagnostics, designed to improve the prevention and treatment of drug-resistant infections.

 

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Rapid phenotypic detection of MRSA colonization

An advanced option for MRSA detection with an easy and flexible workflow that reduces contamination risk and the need to monitor on-board supply of reagents.

 

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MRSA/SA test

For the direct detection of methicillin-resistant Staphylococcus aureus (MRSA) and Staphylococcus aureus (SA) DNA from nasal swabs to aid in the prevention and control of these infections in healthcare settings.

 

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BRAHMS Procalcitonin (PCT)

A sensitive and specific biomarker of the inflammatory response to bacterial infection that aids clinicians in determining a patient’s risk of progression to sepsis and septic shock.

 

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References
 
  1. World Health Organization. New report for urgent action to avert AMR crisis. https://www.who.int/news-room/detail/29-04-2019-new-report-calls-for-urgent-action-to-avert-antimicrobial-resistance-crisis. Accessed June 18, 2020.
  2. Hersh AL, Shapiro DJ, Pavia AT, Shah SS. Antibiotic prescribing in ambulatory pediatrics in the United States. Pediatrics. 2011;128(6):1053-1061.
  3. Centers for Disease Control and Prevention. 1 in 3 antibiotic prescriptions unnecessary. https://www.cdc.gov/media/releases/2016/p0503-unnecessary-prescriptions.html. Accessed June 18, 2020.
  4. Centers for Disease Control and Prevention. Antibiotic use by healthcare setting. https://www.cdc.gov/antibiotic-use/stewardship-report/outpatient.html Accessed June 18, 2020.