Preventing the Next Pandemic Means Addressing the AMR Burden NOW!

Dr. Eran Eden 18 November 2020

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.

However, even as one crisis rises, the threat of AMR doesn’t go away. Approximately 500 people a day in the United States die of infections from antibiotic-resistant organisms.

If COVID-19 is a very well-publicized pandemic, AMR is a silent one. The two are much more closely linked than many are aware, as although SARS-CoV-2 is a virus and not a bacterium, the crisis is resulting in much higher rates of antibiotic prescriptions. Recent CDC data for the US showed that antibiotics were used in 68% of COVID-19 positive patients, compared to 46% in COVID-19 negative patients.

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.

MeMed’s host-immune response technology can help to find order in this chaos. It can help to seek out the low percentage of COVID-19 patients who do have a co-infection in a way that other technologies and diagnostic tools currently can’t. The MeMed BV® test is ideal for this approach because it can identify a bacterial infection unobtrusively, and it bypasses the need for access to difficult infection sites. The test can be done without excessive interruption to patient management or to the treatment course. The test runs on our MeMed Key® platform, which can return results in 15 minutes. The platform allows us to conduct sensitive, rapid, and sophisticated protein measurements at the point of need for patients, that previously could only be done on central lab equipment.

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.

However, even as one crisis rises, the threat of AMR doesn’t go away. Approximately 500 people a day in the United States die of infections from antibiotic-resistant organisms.

If COVID-19 is a very well-publicized pandemic, AMR is a silent one. The two are much more closely linked than many are aware, as although SARS-CoV-2 is a virus and not a bacterium, the crisis is resulting in much higher rates of antibiotic prescriptions. Recent CDC data for the US showed that antibiotics were used in 68% of COVID-19 positive patients, compared to 46% in COVID-19 negative patients.

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.

MeMed’s host-immune response technology can help to find order in this chaos. It can help to seek out the low percentage of COVID-19 patients who do have a co-infection in a way that other technologies and diagnostic tools currently can’t. The MeMed BV test is ideal for this approach because it can identify a bacterial infection unobtrusively, and it bypasses the need for access to difficult infection sites. The test can be done without excessive interruption to patient management or to the treatment course. The test runs on our MeMed Key platform, which can return results in 15 minutes. The platform allows us to conduct sensitive, rapid, and sophisticated protein measurements at the point of need for patients, that previously could only be done on central lab equipment.

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.

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