Over the past few decades, overuse of antibiotics has contributed to the increasing development of antibiotic-resistant so-called “superbugs”— i.e., dangerous bacterial and fungal infections that are now responsible for more than 2.8 million infections and 35,000 deaths in the United States each year. Even amid the ongoing COVID-19 pandemic, antimicrobial resistance (AMR) in hospitalized patients is still a major risk, one that can actually be further exacerbated by COVID treatment. A recent U.S. multi-center study reported that 72% of COVID-19 patients received antibiotics even when not clinically indicated.
In October 2020, the CDC released an updated action plan for combating drug-resistant bacteria over the next five years with objectives tied to non-drug solutions, including new diagnostics, expanded AMR surveillance and data-sharing programs among hospitals. As we face a pandemic of drug resistance underlying the global infectious disease pandemic of COVID-19, healthcare workers should explore technology solutions that facilitate and simplify the detection of drug-resistant infections and tracing of outbreak origins, as well as those which offer treatment insights to enable smarter, more effective use of antibiotics.
Know Before You Go: Rapid Diagnostics
Most antibiotics are prescribed before or without knowing the pathogen and its susceptibility to antibiotics, and therein lies the crux of the matter. Before administering antibiotics, healthcare workers should be aware of what specific pathogen(s) they are treating because different bugs may respond differently to antibiotics, particularly if drug-resistant pathogens are encountered. Overuse or inappropriate use of antibiotics clearly drives the evolution of AMR and can lead to the development of drug-resistant infections in patients. There is a critical need for using rapid molecular diagnostics when warranted. Rapid molecular panels that deliver accurate diagnostics in hours, rather than days, can have a favorable impact on clinical utility when they are integrated into the standard of care testing practices. These panels identify a broad, comprehensive range of pathogens and antibiotic resistance markers with a high degree of specificity and sensitivity, and they do so in significantly shorter time than conventional culture tests and with much less hands-on time required, allowing earlier selection of appropriate and targeted antibiotics instead of prolonged use of empiric broad-spectrum anti-infectives.
Faster infectious disease diagnostics not only have the potential to reduce the use of frontline antibiotics, they can also help doctors gain a broader picture of their patients’ conditions. The latter is incredibly important, especially when treating hospitalized patients or those in the ICU, as we’ve seen with many COVID-19 cases. Rapid molecular diagnostics empower doctors to create treatment plans that directly address specific pathogens causing symptoms. Faster, more reliable results also provide healthcare workers with crucial patient data that can help reduce the risk of transmission and superspreading of bacterial or fungal infections within facilities.
As doctors look to create this treatment roadmap, cultivate antibiotic stewardship and share data on pathogen behavior and treatment courses, incorporating bioinformatics platforms can ease the burden of tracking, analyzing and managing the use of antibiotics.
See the Big Picture: Cloud-Based Data Sharing and Bioinformatics
Electronic health records and clinical decision support systems have the potential to enhance antimicrobial stewardship and enable healthcare providers to more efficiently review microbiology, pharmacy and clinical data. The use of rapid diagnostic platforms in combination with comprehensive electronic health records opens up a new world of opportunities for healthcare professionals looking to fight superbugs and other fast-spreading infectious diseases. And the integration of cloud-based bioinformatics solutions further enhances the realm of opportunities for real-time monitoring of patients, early diagnosis of diseases, patient surveillance solutions, and offers better ways to manage the spread of infectious diseases and helps reduce antibiotic-resistance cases.
Already today cloud-based software technology exists that can enable healthcare providers to identify, track and predict antibiotic-resistant infections based on genetic information. Drawing on large databases that have been compiled over many years, using genotypic and phenotypic profiles from tens of thousands of clinical isolates collected from hospitals worldwide, these AI-powered technologies can predict antibiotic resistance and indeed potentially antibiotic susceptibility (AST) in specific microbes and generate simple reports that tell which drugs are likely to be effective and which ones are likely to be ineffective. Evaluating results from molecular diagnostic tests using these systems provides healthcare workers across multiple facilities with another line of defense against infectious disease outbreaks. With higher quality data available for decision-making, doctors can be alerted of potential cases of drug-resistance or outbreak events more quickly and efficiently, enabling faster treatment decisions.
Adding cloud-based data sharing maximizes the potential value of bioinformatics platforms for healthcare facilities. Making invaluable data like individual diagnostic test results, bacterial genetic information, and treatment outcomes available on data-sharing technology enable further collaboration and problem solving in the infectious disease and AMR space. By adopting digital infrastructure that includes cloud-based data sharing, more facilities can exchange patient data with others in their state or region, breaking down the ‘records gap’ that challenges many healthcare workers seeking medical history for their patients.
With a bioinformatics platform in place, doctors at participating facilities can easily locate comprehensive electronic records for patients under their care, including information on medical conditions and treatments they have received at other hospitals, acute clinics or long-term care facilities. When looking to treat a potentially drug-resistant infection, having a patient’s complete history available can be a difference-maker in treatment decisions as doctors can be alerted of past history with drug-resistance, co-infections or co-morbidities that could adversely impact treatment. Furthermore, some of these platforms allow healthcare professionals to run patient results against pathogen databases from regional facilities to gain insights into outbreak events and resistance markers on a much broader scale.
While healthcare workers focus on the immediate fight against COVID-19 today, we cannot afford to lose sight of the short, medium and long-term threats that AMR poses to public health. To avoid losing ground against these “superbugs”, hospital systems, state governments and individual healthcare executives should explore technology solutions that empower doctors and patients to use antibiotics more responsibly. We must invest in rapid diagnostic technologies, pilot programs exploring precision medicine solutions and data-sharing technologies that have the potential to positively impact treatment outcomes, infection control practices and help improve antibiotic stewardship.