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Is there a solution for antimicrobial resistance?

Microbiology laboratories are the hub which often diagnoses infections and whose results indicate the antimicrobial of choice
© BSAC

Antimicrobial resistance (MR) is a global issue. New resistance mechanisms are emerging and spreading, threatening our ability to treat common infectious diseases and resulting in prolonged illness, disability and death.

AMR also increases the cost of health care with lengthier stays in hospitals and the requirement of more intensive care. It is putting the gains of the Millennium Development Goals at risk, and now endangers the achievement of the Sustainable Development Goals as well.

Microbiology laboratories can play an important role in supporting AMS, as they are the hub which often diagnoses infections and whose results indicate the antimicrobial of choice.

Supporting laboratories

To ensure AMS is supported within the laboratories, the following 6 D’s of AMS can be followed:

6D's of AMS - Diagnosis, Debridement, Drug, Dose, Duration, and De-escalation.

  1. Diagnosis – make and document the right diagnosis e.g. perform rapid testing for pathogens difficult to identify with standard microbiology procedures.
  2. Debridement/drainage – drainage of abscesses and removal of necrotic tissue, e.g. prioritise cultures of specimens from operating rooms and interventional radiology.
  3. Drug – use the right drug empirically according to suspected or confirmed diagnosis alongside other patient/pathogen factors, e.g. contact clinicians directly and promptly in unusual cases and provide guidance for testing and therapy.
  4. Dose – use the right dose according to diagnosis, site of infection and hepatic/renal impairment, e.g. collaborate with pharmacists and ID physicians to improve reporting of MICs for dosing based on PK targets.
  5. Duration – use the drug of choice for the appropriate amount of time, e.g. performing biomarker tests to inform therapy duration.
  6. De-escalation – re-evaluate diagnosis and therapy routinely and de-escalate therapy to narrow-spectrum agents when appropriate, e.g. leverage opportunities to append clinical guidance to microbiological reports.

Essential, achievable and aspirational activities

Morency-Potvin et al described many activities that can be labelled as essential, achievable or aspirational for microbiology laboratories to participate in to contribute to antimicrobial stewardship.

Below are a few examples. Click here for the full review.

Stewardship activity level Activity
Essential Results must be provided in a timely manner, that are reliable, reproducible and include antimicrobial susceptibility tests
Essential For specific multi-drug resistant organisms, alert systems need to be developed
Achievable Be involved in establishing biomarker protocols
Achievable Guidelines to be provided for the interpretation of microbiology test results
Aspirational Extend the use of validated rapid diagnostic testing and rapid antimicrobial susceptibility testing
Aspirational To evaluate the feasibility and possibly, perform testing for susceptibility to new drugs

 

In short, microbiology laboratories are important facilities and have a vast potential to help support and improve AMS.

© BSAC
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Introduction to Practical Microbiology

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