Antibiotic misuse is a significant public health concern and economic burden worldwide. Misuse relates both to overuse when treating a non-bacterial disease, such as a viral infection for which antibiotics are ineffective, and to underuse in cases of bacterial disease for which antibiotic treatment was delayed or not given and would have benefited the patient.
Antibiotic overuse is a common phenomenon, with the global overuse rate estimated at 40-70%. For example, according to the US Centers for Disease Control and Prevention (CDC), over 80 million antibiotic prescriptions are given in the US annually in the outpatient setting to treat viral infections, for which they are ineffective and inappropriate. Over-prescription of unnecessary antibiotics may cause adverse events such as allergic reactions, antibiotic-associated diarrhea, intestinal yeast infection, etc. These preventable adverse events negatively impact patient care and typically are associated with prolonged hospital stay. Antibiotic overuse is also driving the emergence of multi-drug resistant bacteria–one of the biggest healthcare problems of our time.
Antibiotic underuse may lead to prolonged disease duration and increased rate of disease-related complications, both of which may be avoided with prompt treatment of the bacterial infection. Underuse is fairly common. For example, up to 15% of adult patients hospitalized for bacterial pneumonia in the US receive delayed or no antibiotic treatments even though early treatment of bacterial pneumonia is known to save lives and reduce complications. Presently, a “watchful waiting” approach is being adopted in certain clinical situations in an attempt to reduce antibiotic overuse. Namely, antibiotics are prescribed only after a waiting period, during which the disease has not proved to be self-limiting. This approach is not without limitations as it may lead in some cases to antibiotic underuse and its associated hazardous consequences. For more information visit: MeMed BV: Viral vs Bacterial Infection Lab Test
Pulcini et al., Eur J Clin Microbiol Infect Dis, 2007.
Davey et al., Emerg Infect Dis, 2006.
Cadieux et al., CMAJ, 2007.
Linder et al., JAMA, 2001.
CDC (Centers for Disease Control and Prevention), the Get Smart program.
“When you talk, you are only repeating what you already know. But if you listen, you may learn something new.”– The Dalai Lama
In order to create a healthy society, we need to listen to each other. Just about every country is in crisis of non-listening. And in order to cultivate a physically healthy society, we need to listen to the body.
Listening, as a diagnostic approach, dates back to earliest days of medicine, as some of the earliest known medical manuscripts from 17th century BC show. Hippocrates was known to shake patients by the shoulders and then listen to the sounds produced by their chests. It took until the early 19th century for René Laennec to invent the stethoscope, and to coin the term ‘auscultation’ to describe the practice of listening to the body. As a flutist as well as a medical doctor, Laennec knew the importance of listening closely: he was a man who “knew how to listen,” as Dean Benjamín Juárez of Boston University points out.
Since then, you could argue that medicine has been on one long, continual mission to improve the accuracy and the nuance with which we can listen to the body. At MeMed, that’s been our singular pursuit since 2009. Our focus has been to innovate around a very specific mode of listening – the host-immune response – which involves listening to what our own immune systems are telling us. Because the immune system is so complex, and decoding its signals requires such sophisticated techniques and equipment, we’ve come to describe our mission as one of Deep Listening.
“The first duty of love is to listen.” -Paul Tillich
MeMed’s mission is to take the understanding of the immune system into new and often unexpected places. In addition to protecting our bodies from hostile invaders – in fact, as a result of that task – our immune systems are extraordinarily sensitive and accurate detection mechanisms.
What we’re learning at MeMed, however, is that this process involves a chorus of complex signaling, known as the Host-Immune Response, which kicks in when the body is under different kinds of attack. Our MeMed BV test has been tuned using understandings gained by AI and machine learning to identify three biomarkers: IP-10, CRP, and TRAIL. Our BV Test, together with our immunoassay platform called MeMed Key, which can run the test, have delivered results that include 97% AUC in independent, double-blind tests with over 20,000 patients. That’s a lot of global listening.
Our Deep Listening model also brings advantages to the medical community beyond just speed and accuracy, as important as they are. Because we are paying attention to immune markers which circulate freely throughout the body, rather than chasing down pathogens, we can diagnose cases where the infection site is not easily accessible or is simply unknown, as, for instance, in the case of a fever with no known source. Our test can also can distinguish between bacteria and viruses that are merely bystanders hanging around and watching the action, rather than causing the disease.
And of note at this moment, our Deep Listening approach to the immune system can be applied to pandemics such as Covid-19. MeMed is focused on applying our underlying technology to understanding how various reactions in the immune responses of COVID-19 patients can be turned into actionable insights predicting, the severity of how a patient will react to this disease. Some patients present a hyper-inflammatory immune response and others barely become ill at all. MeMed’s host-response technology can continuously measure the onset and course of COVID-19-induced hyper-inflammation. This essential, ongoing Deep Listening means physicians can be alerted to the right time to administer corticosteroids, or to manage the patient with other measures.
The brilliant immunologist Stefan H.E. Kaufmann summed up the history of this extraordinary field in a wonderful essay he titled “Immunology’s Coming of Age.”
Kaufmann describes an optimistic view of the future of the field we share and cherish, writing: “Ultimately, this system biology approach will provide a far more comprehensive perspective of immunology which will generate new concepts for prevention and treatment of diseases…”
In summary: The deeper we listen, the more we can diagnose, treat, and cure.
*MeMed COVID-19 Severity product is not available for sale in the US and it is not cleared by the FDA for any indication.
Antimicrobial Resistance, or AMR, a global health crisis that has for too long gone under the radar, was in the past few years beginning to receive the attention it deserved. This, however, was before the COVID-19 crisis came along to bring almost all other medical discussions to a halt.
Governmental focus was beginning to move in the right direction. In 2015, the Obama Administration released The National Action Plan for Combating Antibiotic-Resistant Bacteria. A move towards recognising the scope of this global health threat in the US, the plan indicated that at that time, drug-resistant bacteria caused 23,000 deaths and 2 million illnesses each year in the US. The current rate has actually now increased to 35,900 deaths per year. The plan also recognized the threat posed to animal health, agriculture and the economy as a whole, and recommending a doubling of funding to $1.2 billion to combat and prevent antibiotic resistance.
Fast forward to 2020 and COVID-19 dominates headlines and medical conversations. The clinical habits needed to combat AMR have been deprioritized, and a unilateral action plan designed to combat it feels like a distant hope. The virus has also polarized patient management strategies, with under-pressure physicians resorting to prescribing antibiotics more readily, even if a bacterial infection hasn’t been identified for certain.
It’s hard to blame physicians outright for this, especially amid a pandemic, when valid concerns lead them to prescribe antibiotics whenever they’re concerned about the possibility of a co-infection. Viruses are known to create a favourable environment in the body for bacteria, who can gather on and around virally infected cells. In addition, antibiotics are often prescribed for their anti-inflammatory properties alone.
However, it remains important to be discerning with the usage of wide-spectrum antibiotics. Wide-spectrum drugs are used to cover the possibility of co-infections in many different treatments where the patient is more vulnerable, from chemotherapy and surgery to dialysis and organ transplantation, which means that overusing these drugs and creating resistant bacteria could threaten patients across the healthcare landscape. Protecting their use is critically important because increasing resistance to these drugs could threaten a huge number of patients, both now and in the future as resistance grows.
So how should we cut down on usage of antibiotics? For decades, it has been common practice to add antibiotics to patient treatment plans whenever it might be appropriate, on the possibility, rather than the certainty, that there might be a bacterial infection present. Cutting down on antibiotic prescriptions will therefore often be a case of deciding exactly when they are needed. Knowing for sure if a bacterial infection was present would reduce incidence of them being prescribed ‘blindly’, which is currently too often the case.
In fact, there’s a growing body of evidence that suggests that COVID-19 doesn’t create particularly favourable conditions for bacterial co-infection at all. A study in Clinical Microbiology and Infection this July found that bacterial co-infection was only identified in 3.5% of patients, with a secondary infection during COVID-19 occurring in 14.3% of patients. Despite this, the study found that 71.9% of these patients received antibiotics. This follows a Lancet study in June which found that out of 195 patients, only 5 had pneumococcal co-infection. The natural conclusion from this is that routine antibiotics are likely not necessary in COVID-19 patients. An additional study in May found that, among 2,000 hospitalized COVID-19 patients worldwide, 72% received antimicrobials, even though only 8% of them had documented bacterial or fungal infections. This makes it even more important to try and determine if bacteria are present, because we are currently risking the overuse of antibiotics in the majority of cases.
Because the technology can listen to a ‘low’ host response, that is, find the signal for a bacterial infection even when expressed alongside a dominant viral response, it would be a valuable tool for physicians dealing with co-infections who want to quickly identify the right patients and reduce the incidence of routine prescription of antibiotics. Tools like MeMed BV and MeMed Key can help to keep up the fight against AMR, even during the pandemic.
A solution to address AMR and prevent mis-prescription of antibiotics has never been more important. Improving antibiotic stewardship requires a multifaceted approach and collaboration across the ecosystem, which isn’t easy. It takes time and investment. But we can still make significant progress by leveraging available host immune response technology to optimize how we manage patients. This could go a long way towards improving patient outcomes right now, and making inroads in the fight against the increasing threat of AMR in the future.
Antimicrobial Resistance, or AMR, a global health crisis that has for too long gone under the radar, was in the past few years beginning to receive the attention it deserved. This, however, was before the COVID-19 crisis came along to bring almost all other medical discussions to a halt.
Governmental focus was beginning to move in the right direction. In 2015, the Obama Administration released The National Action Plan for Combating Antibiotic-Resistant Bacteria. A move towards recognising the scope of this global health threat in the US, the plan indicated that at that time, drug-resistant bacteria caused 23,000 deaths and 2 million illnesses each year in the US. The current rate has actually now increased to 35,900 deaths per year. The plan also recognized the threat posed to animal health, agriculture and the economy as a whole, and recommending a doubling of funding to $1.2 billion to combat and prevent antibiotic resistance.
Fast forward to 2020 and COVID-19 dominates headlines and medical conversations. The clinical habits needed to combat AMR have been deprioritized, and a unilateral action plan designed to combat it feels like a distant hope. The virus has also polarized patient management strategies, with under-pressure physicians resorting to prescribing antibiotics more readily, even if a bacterial infection hasn’t been identified for certain.
It’s hard to blame physicians outright for this, especially amid a pandemic, when valid concerns lead them to prescribe antibiotics whenever they’re concerned about the possibility of a co-infection. Viruses are known to create a favourable environment in the body for bacteria, who can gather on and around virally infected cells. In addition, antibiotics are often prescribed for their anti-inflammatory properties alone.
However, it remains important to be discerning with the usage of wide-spectrum antibiotics. Wide-spectrum drugs are used to cover the possibility of co-infections in many different treatments where the patient is more vulnerable, from chemotherapy and surgery to dialysis and organ transplantation, which means that overusing these drugs and creating resistant bacteria could threaten patients across the healthcare landscape. Protecting their use is critically important because increasing resistance to these drugs could threaten a huge number of patients, both now and in the future as resistance grows.
So how should we cut down on usage of antibiotics? For decades, it has been common practice to add antibiotics to patient treatment plans whenever it might be appropriate, on the possibility, rather than the certainty, that there might be a bacterial infection present. Cutting down on antibiotic prescriptions will therefore often be a case of deciding exactly when they are needed. Knowing for sure if a bacterial infection was present would reduce incidence of them being prescribed ‘blindly’, which is currently too often the case.
In fact, there’s a growing body of evidence that suggests that COVID-19 doesn’t create particularly favourable conditions for bacterial co-infection at all. A study in Clinical Microbiology and Infection this July found that bacterial co-infection was only identified in 3.5% of patients, with a secondary infection during COVID-19 occurring in 14.3% of patients. Despite this, the study found that 71.9% of these patients received antibiotics. This follows a Lancet study in June which found that out of 195 patients, only 5 had pneumococcal co-infection. The natural conclusion from this is that routine antibiotics are likely not necessary in COVID-19 patients. An additional study in May found that, among 2,000 hospitalized COVID-19 patients worldwide, 72% received antimicrobials, even though only 8% of them had documented bacterial or fungal infections. This makes it even more important to try and determine if bacteria are present, because we are currently risking the overuse of antibiotics in the majority of cases.
Because the technology can listen to a ‘low’ host response, that is, find the signal for a bacterial infection even when expressed alongside a dominant viral response, it would be a valuable tool for physicians dealing with co-infections who want to quickly identify the right patients and reduce the incidence of routine prescription of antibiotics. Tools like MeMed BV and MeMed Key can help to keep up the fight against AMR, even during the pandemic.
A solution to address AMR and prevent mis-prescription of antibiotics has never been more important. Improving antibiotic stewardship requires a multifaceted approach and collaboration across the ecosystem, which isn’t easy. It takes time and investment. But we can still make significant progress by leveraging available host immune response technology to optimize how we manage patients. This could go a long way towards improving patient outcomes right now, and making inroads in the fight against the increasing threat of AMR in the future.
