Improving our approach to fighting AMR
Oliver Schacht, CEO of precision medicine and genomics analysis company OpGen explores what we need to do to improve our fight against antimicrobial resistance (AMR).
Though many in the United States are already putting the Covid-19 pandemic behind them, we are neither out of the woods nor are we doing everything we can to stop the next pandemic in its tracks. An increasingly growing concern, antimicrobial resistance (AMR), has been on the radar of the health community for years, though it has yet to spark widespread concern within the general public. And unfortunately, the Covid-19 pandemic, and particularly our response and treatment plans in its early stages, has only served to exacerbate the threat of AMR.
When examining the causes for AMR a few things immediately come to mind. The first is antibiotic overuse, with global consumption up 39% from 2000-2015 and noted over-prescription of antibiotics in Covid-19 patients. On a more macro level, the lack of education on infection control practices is also detrimental to the AMR cause. And more practically, inadequate access to rapid testing and outbreak monitoring technologies, insufficient data sharing policies and a lacking emphasis on global collaboration all contribute to the threat of AMR. In order to take this threat seriously, the healthcare community needs to prioritise a global, unified approach. But in the meantime, here are some steps to minimise the effects of AMR before it spirals out of control.
Increase investment into rapid testing and tracing technologies
While researching drug alternatives can often dominate discussions around AMR, paying more attention to diagnostic practices as well as infection surveillance and tracing technologies serves an equally important role. Molecular polymerase chain reaction, or PCR tests, have gotten a lot of attention with respect to Covid-19 in the past year, but these types of rapid testing panels also have the potential to make antibiotic stewardship programmes more impactful. By incorporating these rapid tests into standard of care, medical professionals can avoid needlessly prescribing unnecessary, broad-spectrum antibiotics. And though the medical community understands the general importance of updating the standard of care, the real problem is two-fold.
The healthcare community not only needs to prioritise research into these rapid test panels, but also ensure that all healthcare facilities have access to these technologies and eventually incorporate them to the degree that they are considered common practice, and that doctors frequently wait for the results before administering antibiotic treatment. This includes encouraging regulatory bodies to place greater importance on these tests, even granting an accelerated review process when possible, and making certain that access to the multiplex molecular panels does not discriminate against a facility’s location, size or patient demographics.
Enhance communication across the global medical community and general public
One of the most basic, and often overlooked, approaches to reducing infection rates is creating an emphasis on public education around transmission. Antimicrobial stewardship programmes have demonstrated success in lowering both the financial burden of drug-resistance and AMR rates. When examining countries where transmission rates are higher than antibiotic prescription rates, research suggests that countries with high rates of AMR can be attributed to poor infection control practices. As such, healthcare organisations must provide consistency in goals and accountability, as well as best practices, across all facilities to ensure they are equipped to provide informed patient care and have the knowledge and tools required to deal with outbreak threats.
But beyond the medical community, we need to prioritise conveying AMR education to the general public, as well, especially as people are eager to re-enter a post Covid-19 quarantine world. With travel on the rise, consider a recent study in Genome Medicine. The study found a significant increase in the abundance and diversity of AMR genes in the gut resistome of travelers after international trips. As these resistance genes also travel the globe, albeit unknown to the traveler, the threat takes on a new level of global significance. By increasing awareness around AMR transmission, we can work to minimise the spread of global pathogens.
Envision global, equitable access
We’ve established that AMR is a global threat with cross-border origins. As such, the logical approach to tackle the threat is with a truly global plan that emphasises equitable access. In order to be effective, NGOs, multilateral organisations such as the G20, medical industry groups, global governments, frontline healthcare workers and even patients themselves need to work together to address this threat. In short, all involved parties, regardless of country, wealth, or infection rates, need to do better across the board.
Multilateral collaboration will be key, and this manifests in multiple ways. First, data sharing on local, state and national as well as international levels can provide deeper insights into patient care approaches as well as serve to alert the health community to potential outbreaks sooner rather than later. Cloud-based AMR surveillance platforms continue to go through pilots around the world, securing test results and patient data, to be uploaded into shared databases for analysis against other facilities. But even on a more micro scale, healthcare facilities on the local level can increase collaboration when it comes to monitoring general outbreaks, catching them sooner and hopefully decreasing the amount of antibiotics prescribed when a drug-resistant pathogen is identified.
AMR does not discriminate against particular countries, and neither can our approach to this threat. Where artificial intelligence (AI) and whole genome sequencing (WGS) data models are becoming more prevalent in high-income countries, we must extend this approach to lower to middle-income countries where outbreaks have the potential of spreading unchecked. A recent study published in Frontiers in Cellular and Infection Microbiology detailed best-practices for using AI to predict AMR from WGS models. By using a prediction model combination technique suitable for small data sets, researchers were able to improve the average specificity and sensitivity of the individual models. By increasing access to AI and machine learning models, we can improve outbreak response and further facilitate the adoption of surveillance technologies globally.