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Syndromic Diagnostics Help Combat AMR

Research provides a compelling look at the global impact of antimicrobial resistance—and the results are alarming. Looking at data from 204 countries and territories, researchers estimated there were 1.27 million global deaths directly attributable to antibiotic-resistant bacterial infections in 2019.1 Overall, 4.95 million deaths were associated with antibiotic resistance.1

Based on those findings, an editorial in Lancet describes the global burden of antimicrobial resistance as "likely to be higher than that of HIV or malaria."2

"Understanding the burden of AMR and the leading pathogen-drug combinations contributing to it is crucial to making informed and location-specific policy decisions," the study authors state.1 The enormous toll bacterial AMR takes on people throughout the world underlines the importance of combatting antibiotic resistance with every tool available, including effective infection control and prevention, vaccination programs and the development of new vaccines, and continuing research and development of new antibiotics.

Effective diagnostics are another vital tool in the fight against antibiotic resistance. Timely diagnostic answers can help reduce the use of unnecessary antibiotics and, when antibiotics are needed, help ensure they are appropriately targeted.

Syndromic testing from BIOFIRE can help give clinicians the answers they need in a clinically relevant timeframe. Using the syndromic approach, BIOFIRE® FILMARRAY® Panels detect a broad grouping of possible pathogens in one quick test. Some of the BIOFIRE Panels also detect relevant antimicrobial resistance genes, enabling clinicians to further optimize treatments.

In fact, the BIOFIRE Panels have been shown to impact therapy decisions and antibiotic use. Read on to learn how multiplex PCR testing with the BIOFIRE Panels may help reduce unnecessary antibiotic use and support antibiotic stewardship programs.

Respiratory Infections

Respiratory infections are difficult, if not impossible, to diagnose based on symptoms alone. A wide range of respiratory pathogens can cause similar symptoms. In the absence of clear answers, many patients want antibiotics in the hope they will help alleviate symptoms. As a result, only 50% of antibiotic prescriptions for acute respiratory infections were estimated to be appropriate in the ambulatory setting.3

Taking a syndromic approach, the BIOFIRE® Respiratory 2.1 (RP2.1) Panel provides comprehensive answers, giving clinicians the information they need to make informed treatment decisions. In about 45 minutes, the BIOFIRE RP2.1 Panel detects 22 pathogens associated with respiratory infections, including SARS-CoV-2, influenza, respiratory syncytial virus, four relevant bacteria, and more.

This comprehensive, syndromic testing approach can help reduce unnecessary antibiotics. For example, use of the first-generation BIOFIRE® FILMARRAY® Respiratory (RP) Panel resulted in antibiotic avoidance for 13% of adult patients tested, compared to the standard of care.4

Additionally, the BIOFIRE® FILMARRAY® Respiratory EZ (RP EZ) Panel significantly increased the appropriate use of antimicrobials, even in a setting with a strong antimicrobial stewardship program.5

When it comes to pneumonia, patients often receive empiric antimicrobials because it can be difficult to quickly pinpoint the causative pathogen. The BIOFIRE® FILMARRAY® Pneumonia (PN) Panel detects a broad menu of targets commonly associated with pneumonia, including bacteria, viruses, and antimicrobial resistance genes. The panel provides semi-quantitative results for 15 of the bacteria, which may help clinicians determine whether they are true pathogens.

Fast and comprehensive answers with multiplex PCR testing can help clinicians provide timely and targeted treatment for pneumonia patients. One study found that up to half of all antibiotic courses could have been de-escalated with use of the BIOFIRE PN Panel.6

Gastrointestinal Infections

Several gastrointestinal pathogens are associated with antibiotic resistance. In fact, E. coli is associated with the most antimicrobial resistance-related deaths, making it particularly dangerous for patients.1

Many pathogens can cause infectious gastroenteritis—but the symptoms are similar, no matter the infectious cause. Traditional stool testing methods are slow, labor intensive, and lack sensitivity, often leaving clinicians to make treatment decisions without a laboratory result. Fortunately, syndromic testing with the BIOFIRE® FILMARRAY® Gastrointestinal (GI) Panel can help quickly reveal an infectious etiology. The BIOFIRE GI Panel identifies 22 targets associated with gastrointestinal illness, including bacteria, viruses, and parasites, with results in about an hour.

This syndromic testing approach can impact therapeutic decisions. For instance, use of the BIOFIRE GI Panel has been shown to lead to 17% more targeted therapy7 and make antibiotic prescriptions 11% less likely.8

Bloodstream Infections

Bloodstream infections are serious and can quickly become fatal. Following onset of septic shock, for example, patient survival declines by 7.6% for every hour of delay in treatment.9 Due to this urgency, patients with bloodstream infections are often treated empirically, leading to antimicrobial overuse.

The BIOFIRE® Blood Culture Identification 2 (BCID2) Panel can help provide clinicians with the answers they need to make timely and targeted treatment decisions. The BIOFIRE BCID2 Panel detects 43 targets, including Gram-positive bacteria, Gram-negative bacteria, yeast, and antimicrobial resistance genes. Results take about an hour from positive blood culture.

The need to quickly treat patients with bloodstream infections is often in tension with the goals of antimicrobial stewardship programs. The ISDA recommends including rapid diagnostic testing to antimicrobial stewardship programs,10 and studies have shown that the first-generation BIOFIRE® FILMARRAY® Blood Culture Identification (BCID) combined with antimicrobial stewardship provides the greatest benefit.11 In fact, antimicrobial stewardship combined with the BIOFIRE BCID Panel resulted in about a 25% reduction of broad-spectrum antibiotics.11

Meningitis/Encephalitis

Meningitis is considered a medical emergency. Bacterial meningitis can be fatal in otherwise healthy people within 24 to 48 hours.12 However, it's challenging to tell the difference between bacterial and viral meningitis based on clinical presentation alone. That's why clinicians often start patients on empiric antibiotic therapy before diagnostic results are available.

The BIOFIRE® FILMARRAY® Meningitis/Encephalitis (ME) Panel detects 14 targets, including bacteria, viruses, and yeast, with results in about an hour. Rapid results from this comprehensive panel can help distinguish between bacterial and viral infections, giving clinicians the information they need to make targeted treatment decisions and de-escalate antimicrobials when appropriate.Studies have found that the BIOFIRE ME Panel led to a 2-day reduction in both acyclovir and antibiotic duration for both adult and pediatric patients.13,14

Syndromic Testing Can Help in the Fight Against Antibiotic Resistance

The AMR researchers describe antimicrobial resistance as "one of the leading public health threats of the 21st century," noting that a report commissioned by the UK government argued that antimicrobial resistant infections could kill 10 million people per year by 2050.1

"If left unchecked, the spread of AMR could make many bacterial pathogens much more lethal in the future than they are today," the authors state.

That's why it's crucial to use every tool in the toolbox to slow the spread of antibiotic resistance. Fast, accurate, and comprehensive diagnostics are a key component of a multi-pronged approach to combatting antibiotic resistance. Timely diagnostic results give clinicians the information they need to optimize therapy and reduce the use of unnecessary antimicrobials.

References

  1. Antimicrobial Resistance Collaborators. Lancet. 2022 Feb 12;399(10325):629-655.
  2. Lancet editorial. Lancet. 2022 Feb 12;399(10325):
  3. Fleming-Dutra KE, et al. JAMA. 2016;315(17):1864-1873.
  4. Echavarria J Clin Virol. 2018;108:90-95.
  5. Beal SG, et al. Pediatr Infect Dis J. 2020;39(3):188-191.
  6. Buchan B.W. et al. American Thoracic Society Conference, May 2018, San Diego CA.
  7. Cybulski R, et al. Clinical Infectious Diseases. 2018;67(11):1688-1696.
  8. Axelrad JE, J of Clin. Microbiology. 2019; 27;57(3). e01775-18.
  9. Kumar A, et al. Crit Care Med. 2006; 34(6):1589-96.
  10. Barlam T, et al. Infectious Diseases Society of America. 2016 May 15;62.
  11. Banerjee R, et al. Clin Infect Dis. 2015;61:1071-80.
  12. Confederation of Meningitis Organisations Fact Sheet. comomeningitis.org/facts. 2020.
  13. Moffa M, et al. Antibiotics (Basel) 2020;9(6):282.
  14. Hagen A, et al. BMC Pediatrics.2020;20(56).

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