Rapid molecular diagnostics and antibiotic stewardship

Key for positioning UAE as a global leader in healthcare

By Dr. Hafiz Ahmad (Ph.D– AIIMS, New Delhi, PDF- NIH, USA), Assistant Professor and Clinical Microbiologist, Department of Medical Microbiology and Immunology, RAK College of Medical Sciences, RAK Medical & Health Sciences University and Adjunct Clinical Microbiologist, RAK Hospital, Ras Al Khaimah, UAE

Antimicrobial agents have long been used for treating patients with infectious diseases, reducing morbidity and mortality. Antibiotics can be lifesaving when treating bacterial infections. But because of inappropriate use, over or under dosing and excess use in animal feed and plant manures, has generated resistant forms known as Multi Drug Resistant Organisms (MDRO). Studies indicate that up to 50 per cent of antibiotic use is either unnecessary or inappropriate across all type of healthcare settings.

Antibiotic Stewardship is needed to ensure prompt appropriate clinical decision. This will translate rapid diagnostic test results in the laboratory into improved patient and clinical outcomes.

It is important to select the right test for the right patient at the right time to optimally influence patient management and conserve healthcare resources and reduce turnaround time (TAT).

The rationale for utilisation of rapid diagnostic molecular technology coupled with antimicrobial stewardship is necessary for the accurate and rapid identification as well as characterisation of resistant super bugs like Methicillin-resistant Staphylococcus aureus (MRSA), ESBL- producing Enterobacteriaceae, Carbapenem-resistant Enterobacteriaceae (CRE) ensuring appropriate improved patient management, resulting in decreased hospital stay and decreased costs. Hence, reduction in morbidity and mortality. A recent study implementing advanced Antibiotic Stewardship Programme (ASP) at Cleveland Clinic, Abu Dhabi has reported US$ 1,339,499 total direct cost savings, despite significant increase in patient discharges. Thereby, decreasing antimicrobial utilisation, antimicrobial expenditure and reduction in hospital acquired C. difficile and MDR rates.

Rapid molecular diagnostic tests are “game changer” for patient care especially in cases with diagnostic uncertainty. With the introduction of Polymerase Chain Reaction (PCR), multiplex PCR panels, Matrix Assisted Laser Desorption/Ionization Time of Flight mass Spectrometry (MALDI-TOF MS) and Next-generation sequencing (NGS) to identify organisms directly from specimens, has significantly reduced the window of testing for diagnosing bloodstream, respiratory tract, urinary tract, gastrointestinal and central nervous system infections. Once the appropriate rapid tests have been selected, it is important to use the test for the right patients to affect optimal clinical care – Diagnostic Stewardship.

Nevertheless, clinicians, Infectious Disease specialists and antibiotic stewards will always guide to decide between definitive negative results, colonisation versus true infection, based on clinical acumen taking into account clinical history and physical examination as nucleic acid-based testing does not always equate to viable organism detection. Therefore, synergy of ASP team and diagnostic laboratory is key for proper implementation and optimal clinical outcomes.

The UAE ASP team along with national Antimicrobial Resistance (AMR) provides national clinical guidelines based on data of local resistance patterns of antibiotics for the management of common infectious diseases and reducing emergence of MDROs in the region. Furthermore, having an ASP is now a requirement for hospitals to be accredited through The Joint Commission and Joint Commission International (JCI).

Thus, amalgamation of ASP and Rapid Molecular methods along with high quality nursing and pharmacy care have profound impact on healthcare in the UAE and the Middle East and drives the way forward for positioning the country as a global leader in healthcare.

References available on request.

Dr. Ahmad is a member of national ASP for UAE and will be speaking on “Rapid molecular diagnostics & antibiotic stewardship” on October 25, day two of the Infection Control Conference, at Patient Safety Middle East.