Putting antibiotic resistance to the test

Could you tell us a bit about your background and experience?

Felicia Longobardi: I have around 25 years of experience working in the field. I spent many years observing the value of antibiotics while working as a chemical engineer producing large-scale antibiotics. Later on, while working in the surgical field, I observed how antibiotic resistance has life or death consequences for many patients. I became a passionate advocate for antibiotic stewardship after I moved into the rapid diagnostics field, seeing the potential rapid diagnostics had to change antibiotic prescribing and impact the use of life-saving antibiotic treatment for future generations.

What is the estimated global impact of antibiotic resistance?

Antibiotic resistance is one of the greatest threats to global health and is accelerated mainly by the misuse and unnecessary prescription of antibiotics. There is a direct relationship between the prescribing of antibiotics and the development of antibiotic resistance.

About 70% of respiratory tract infections are viral, and many others are minor self-limiting bacterial infections, where the use of antibiotics is inappropriate. There is concern that a lack of new antibiotics will threaten global efforts to contain antibiotic resistant infections and hence we should strive to preserve existing agents and not use them indiscriminately. There has been some progress in reducing antibiotic use in primary care in some countries, but not in others, and there is a wide range of prescribing rates across the globe.

The prescription of antibiotics at both the community and hospital level needs better management. It needs to be addressed through national strategies to improve diagnostics, develop new antibiotics and promote antibiotic stewardship.

What is point-of-care testing and how can it help reduce antibiotic resistance?

Point-of-care testing is any diagnostic test performed at or near to the site of the patient, with results made immediately available to aid in the care of that patient. Essentially it is a laboratory test conducted outside of the laboratory setting.

With point-of-care testing, patients and their care providers can make management decisions at the time of the visit of a patient. Results are available within minutes and can be discussed with the patient immediately. Besides potential clinical benefits, this offers the physician greater certainty for patients presenting without laboratory results.

Point-of-care testing has also been shown to improve practice workflow and lead to operational and economic benefits. For patients, point-of-care testing is more convenient and increases understanding, motivation and satisfaction.

C-reactive protein point-of-care testing can help fight against antibiotic resistance, as discussed in our recent webinar: Fighting forwards: how to keep antibiotics working in an age of resistance.

Most antibiotics are prescribed for respiratory tract infections in the primary care setting. C-reactive protein point-of-care testing has been shown to reduce antibiotic prescribing in respiratory tract infections without impacting clinical measures, such as rate of recovery or mortality.

What differences are there between countries for point-of-care pathways?

A recent survey found that EU countries using C-reactive protein point-of-care testing, were the lowest 12 prescribers of antibiotics; these were Finland, the Netherlands, Denmark, Norway, Sweden, Germany, Czech Republic, Hungary, Austria, Slovenia, Latvia and Estonia. By comparison, investigations in 2015 reported that Italy had the highest antibiotic consumption in humans out of all EU/EEA member states.

Adoption models for point-of-care testing that have proved successful in EU countries demonstrate a distinct pattern. Early adoption, followed by support from practitioners, especially when embedded in a policy environment that encourages point-of-care technology, and a government drive to reduce overprescription of antibiotics, lays the foundation for a resource allocation model that supports large-scale adoption.

The point-of-care testing patient pathway involves fewer steps than traditional laboratory pathways – regardless of the country in which it is implemented – contributing to lower resource utilisation and less opportunity for patients to exit the care pathway. Given these drivers, adoption should be a key target for all countries yet to implement the approach, and all stakeholders must play their part in advocating for this change.

What are the benefits of rapid diagnostics, such as Afinion C-reactive protein point-of- care testing?

Multiple studies have shown that C-reactive protein point-of-care testing reduces antibiotic prescribing. Adopting diagnostic systems that reduce antibiotic consumption has been described as a “no-brainer” by researchers, for governments that are struggling to address the rise in antibiotic resistance.

Over the past three decades, Abbott has been dedicated to providing the very latest innovations in point-of-care testing, helping to improve diagnostic outcomes for both doctor and patient. The Afinion C-reactive protein point-of-care test provides results in three minutes and features an easy-to-use all-in-one cartridge; gives results comparable with laboratory methods; has no need for user calibration; and is minimally invasive, as it uses finger prick sampling.

How can patient awareness and communication help tackle the overprescription of antibiotics?

Poor patient awareness of antibiotic resistance and patient expectance to get antibiotics play a significant role in the misuse of antibiotics. Clinical challenges, such as consultation time constraints, prescriber anxiety relating to malpractice litigation and poor communication also exacerbate the issue.

In our latest webcast, the patient advocate Vanessa Carter increases awareness for antibiotic resistance with her personal story. It is important to manage prescribing in primary care to protect the lives of those who need surgery in secondary care.

Data from eurobarometer 2018 reported that a large proportion of patients take antibiotics for viral infections and confirmed that 48% of Europeans believed that antibiotics work against the flu and common cold.

Evidence shows that general practitioners who have received training in enhanced communication skills prescribe fewer antibiotics than those who have not. According to research, a combination of training in communication skills and the use of C-reactive protein point-of-care testing could double the reduction rate for antibiotic prescribing.

What other types of point-of-care test are there?

Point-of-care testing is available for a wide range of therapy areas and clinical scenarios. In diabetes patients, for example, HbA1c point-of-care testing can improve testing frequency and also lead to lowered HbA1c values.

Lipid testing, including total, high-density lipoprotein and low-density lipoprotein cholesterol and triglyceride testing, is ideal for screening and managing individuals with, or those at risk of, atherosclerotic cardiovascular disease. Screening programmes have also been implemented with children, using point-of-care cholesterol testing for familial hypercholesterolemia.

As the earliest marker of kidney disease in diabetes and a strong predictor for cardiovascular disease, the albumin-creatinine ratio is an important test also available at the point-of-care, to screen people with cardiovascular risk; for example, those with diabetes or hypertension, or to manage those with already established kidney disease. Unfortunately, screening rates for albumin-creatinine ratio are low, as highlighted by a recent global meta-analysis.

C-reactive protein point-of-care testing can be used for a range of other conditions, like gastro-intestinal disorders, rheumatoid arthritis, sepsis and urinary infections.

Given the wide range of point-of-care tests, many clinics are now adopting a one-stop shop approach, where a patient is tested for multiple parameters on-site, with results immediately analysed by the clinician, discussed with the patient and an appropriate treatment pathway initiated – all in one seamless visit.

How are Abbott supporting education on point-of-care testing and antibiotic resistance?

Our platform, myPOCacademy.com, features a wide range of learning content on point-of-care testing across many of the therapy areas I have mentioned. There are professionally certified webcasts, fact sheets, slide decks, articles, podcasts and expert videos, all featuring internationally renowned medical experts with real-world clinical knowledge on the implementation of point-of-care systems.

Our webcasts include faculty discussions, audience Q&As and patient advocate stories too. Registration is free, quick and easy. Content is also relevant for all healthcare professionals, from clinicians and nurses, to payers, health policy makers and other healthcare system stakeholders.

What does the future hold for point-of-care testing and antibiotic resistance?

With the continued advancement of rapid diagnostics, especially in the wake of the pandemic, patients will expect greater precision in diagnosing and managing their illnesses.

Adopting point-of-care testing systems that reduce antibiotic consumption is critical to address the rise in antibiotic resistance, and a one-stop shop approach will achieve more holistic patient care too.