Beckman Coulter - Antimicrobial-resistant bacteria: a growing problem

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In the late 1930s, almost a decade after Alexander Fleming unwittingly discovered penicillin, the first antibiotics were prescribed to a patient. As its use became more prevalent, life expectancy increased and many believed this to be the end of infectious diseases.

However, even Fleming cautioned against imbuing this new discovery with too much power, telling the New York Times in 1945: "The greatest possibility of evil in self-medication is the use of too-small doses, so that instead of clearing up infection the microbes are educated to resist penicillin and a host of penicillin-fast organisms are bred out, which can be passed to other individuals and from them to others until they reach someone who gets septicaemia or pneumonia, which penicillin cannot save."

Instead of healthcare providers overprescribing this medicine, diagnostics need to be performed to identify AMR pathogens as quickly as possible. This is the only way to prevent the spread of AMR bacteria in hospitals and communities.

Antimicrobial resistance

Time proved Fleming's premonition correct. Indeed, the current antimicrobial resistance (AMR) statistics are alarming: WHO reports that 480,000 people develop multidrug-resistant TB each year, and drug resistance is also starting to complicate the fight against HIV and malaria.

More than half a century after Fleming's bleak prognosis, many new antibiotics have been produced. Unfortunately, for today's patients, the pipeline for antibiotic drugs is limited for serious infections. Historically, antibiotic development has been slow due to a number of business factors.

In an effort to help motivate pharmaceutical companies to create new antibiotics, many regulatory agencies worldwide, including FDA in the US, have created a fast-track process, allowing approved antibiotics to enter the market and be available to patients quicker. Many of these new antibiotics are selective for multidrug resistant (MDR) pathogens. Unfortunately, there is not yet a fast-track process for the corresponding susceptibility lab tests for these new antibiotics, however discussions are under way. The antibiotic crisis has been highlighted by many health bodies and governments. The UK's chief medical officer, Sally Davies, for example, has spoken of a "post-antibiotic apocalypse".

A major factor attributed to AMR is the overuse of antibiotics in human and animal populations. Instead of healthcare providers overprescribing this medicine, diagnostics need to be performed to identify AMR pathogens as quickly as possible. This is the only way to prevent the spread of AMR bacteria in hospitals and communities.

This is the driving force behind Beckman Coulter's MicroScan technology. With its scalable instruments, comprehensive diagnostic tests and business management services for hospitals, laboratories and critical-care settings, the company aims to improve diagnostic capabilities and help healthcare practitioners deliver quality patient care.

Its MicroScan microbiology system is used to detect emerging resistance as it occurs. Reliance on this system provides accurate and timely results without relying on historical data.

Reduced need for confirmatory testing

With more than 35 years of identification and antibiotic susceptibility testing (ID/AST) experience, the MicroScan microbiology system helps to improve workflow by minimising the need for confirmatory retesting. It provides accurate, firsttime results for laboratories of every size.

Indeed, MicroScan products result in the fewest clinically significant FDA drug-bug limitations of any automated ID/AST system. The microbiology instruments use a singlepanel format that enables scalability to suit laboratory and testing demands.

New York-based Dr Susan Whittier is the director of clinical microbiology service, and associate professor of pathology and cell biology at the New York-Presbyterian/Columbia University Medical Center.

Dr Whittier has been using MicroScan technology at the 1,200-bed academic medical centre that provides comprehensive diagnostic services for two adult hospitals and a paediatric hospital, as well as more than 20 neighbourhood and school-based clinics.

The centre's specialties include bacteriology, mycology, mycobacteriology, parasitology, virology, molecular infectious disease testing and molecular epidemiology. It processes roughly 500,000 specimens a year.

"Our patient population consists of a host of critically immunocompromised individuals," Dr Whittier says. "We are a major transplant centre for adults and paediatrics, we have a large haematology/oncology population and we are the largest cystic fibrosis centre for adults and paediatrics in New York City.

"Unfortunately, New York City is also a hot spot for antibiotic resistance, particularly with our Gram-negative bacteria. Every day, we report culture results in which the bacteria is resistant to every single antibiotic tested.

"So then we need to test 'research-use only' agents and try to find synergistic drug combinations. If a patient is colonised with multidrug-resistant Gram-negative rods prior to transplant, they may not be eligible for that transplant because we know that the outcomes are not favourable for these patients," she concludes.

The most common resistance pattern at the centre's laboratory is ESBLs, followed closely by CRE. MicroScan delivers accurate emerging resistance detection for these pathogens, as well as Vancomycin-intermediate Staphylococcus aureus (VISA), Vancomycin-resistant Staphylococcus aureus (VRSA) and Methicillin-resistant Staphylococcus aureus (MRSA).

When it comes to multidrug-resistant organisms (MDROs), Dr Whittier says she feels more comfortable with MicroScan products since the AST is an overnight endpoint.

"We know that resistant subpopulations may grow more slowly, so rapid AST systems might miss these," Dr Whittier says. "Also, the new MDR AST panel for GNRs (MicroScan Detect Neg MIC1) allow laboratories to test alternative regimens for our bacteria that are resistant to what we consider first-line therapy."

Finding the right laboratory fit

The MicroScan WalkAway System is ideal for mid to highcapacity laboratories, and suits 40 and 96-panel capacity models. It uses automated incubation, test interpretation and reagent control, as well as conventional overnight ID/AST and/ or speciality and rapid ID testing on one instrument. It uses real MIC technology to provide accurate results for laboratories to operate efficiently.

Alternatively, the autoSCAN-4 System works well in smallcapacity laboratories or for back-up testing. The system allows automated reading of bacterial ID and susceptibility in seconds. It can test for difficult and slow-growing species, and automatically records and interprets instrument results using a computerised system.

MicroScan panels offer the fewest clinically significant FDA limitations and adhere to guidelines established by all the major microbiology standards organisations including the Clinical and Laboratory Standards Institute (CLSI) and the European Committee on Antimicrobial Susceptibility Testing (EUCAST).

Particularly impressed by the MicroScan panels is Angela Beth Prouse, clinical microbiologist at the Peninsula Regional Medical Center. "The rapid negative ID panels are very useful to us. We see a lot of challenging organisms with nonfermenters, and these panels do a great job with these," she says.

No matter which system is in use, the correlating software, LabPro Alert, provides real-time, automated alerts when atypical results are detected.

Using enhanced data management, the software improves laboratory efficiency by streamlining workflow and making information about patient care easily accessible. Working together in a comprehensive system, the LabPro Information Manager, LabPro AlertEX, and LabPro Connect help standardise and consolidate testing regimens.

They are adaptable to unique laboratory requirements to provide crucial alerts and suggestions about atypical results in real time.

With the MicroScan system and the corresponding LabPro software, laboratory workers can streamline their workflow. Add to this combination the Prompt Inoculation System and the RENOK Rehydrating Inoculator, and MicroScan systems deliver results quickly and accurately.

We know that resistant sub-populations may grow more slowly, so rapid AST systems might miss these. Also, the new MDR AST panel for GNRs (MicroScan Detect Neg MIC1) allow laboratories to test alternative regimens for our bacteria that are resistant to what we consider first-line therapy.

Fast approaching the century mark since Fleming's penicillin discovery, and the world is at a critical stage in fighting bacteria. There is a shortage in the supply of new antibiotics, and the ones we do have are growing increasingly ineffectual.

Providing accurate diagnostics to determine AMR is essential. Not only does it contribute towards saving the life of a particular patient in need of treatment, but it impacts society as a whole, ensuring infectious diseases do not lay waste to our global healthcare systems.

Accurate testing, as provided by the MicroScan system, allows medical practitioners to arm themselves against the resistance and keep their patients safe. As Dr Whittier explains, "Patients lives depend on our results. Accuracy is critical."


MicroScan Detect Neg MIC1 susceptibility test panel includes research-use-only and FDA-approved antibiotics, and is for US distribution only at this time.

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Beckman Coulter, Inc.
Atlanta Vision Center 3353 Peach Tree N.E. Suite 200 Atlanta, Georgia 30326
USA
Atlanta
Client Services Tel: (800) 526-3821 Fax: (800) 232-3828
30326
Georgia
United States of America
URL: www.beckmancoulter.com

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