Point-of-Care Hematology’s Role in Fighting Antimicrobial Resistance (AMR)
30 Aug 2021
The discovery of penicillin revolutionized the field of medicine, giving physicians the tools to combat previously untreatable high-mortality diseases and infections. Common diseases like pneumonia, tuberculosis, and syphilis were no longer a death sentence, and scientists rushed to identify new classes of antibiotics to treat a wider range of pathogens.
Despite their incredible success in treating infection, new challenges have arisen in the field of antibiotics. As the world discovered in the past few months with the various mutations of the Covid-19 virus, microorganisms are never static. Pathogens constantly and randomly mutate, and bacteria can and do develop mutations that make them resistant to specific types of antibiotics. When a bacterium develops a mutation that allows it to survive the drug regimen prescribed to eliminate it, its cells can multiply and breed drug-resistant bacteria. As more antibiotics are prescribed unnecessarily and more mutations occur, Antimicrobial Resistance (AMR) has become an increasingly significant threat to public health.
Viral or bacterial? Differentiating at the point-of-care
One of the primary contributors to the over-prescription of antibiotics is the difficulty in differentiating between viral and bacterial infections, which causes antibiotics to be incorrectly prescribed for viral infections where they have no impact. Therefore, rapid, on-site diagnostics are key to maintaining the effectiveness of antibiotics. Physicians and other clinicians need a simple and effective way to differentiate between bacterial and viral infections so as to only prescribe antibiotics where they are truly needed and prevent their overuse.
Several biomarkers can serve as differentiators, but no single biomarker is sufficient on its own. Since many of the biomarkers cannot be properly assessed in a primary care facility, if a primary care physician suspects a bacterial infection, he or she may prescribe antibiotics on the spot, before receiving conclusive results that the infection is in fact bacterial. Even if the physician instructs the patient to wait to take the antibiotics until the lab results arrive, once the prescription has been given, the physician has no control over patient compliance.
A simple complete blood count (CBC), the most common blood test in the world, is one of the most effective biomarkers in diagnosing bacterial infection. However, despite their ubiquity, simple CBCs are usually done in labs and cannot be conducted at a point-of-care (POC) site, posing a significant obstacle in the fight against AMR.
New technological horizons
New technologies are now being developed to enable primary caregivers to conduct CBCs at the point of care, empowering primary caregivers to make more accurate diagnoses. When paired with additional, existing POC diagnostics for infection biomarkers such as C-reactive proteins or procalcitonin, these innovative tests have the potential to support accurate clinical decision-making and significantly reduce unnecessary antibiotic prescriptions.
Currently, most CBCs are performed on complex hematology analyzers operating in central laboratories. While these systems deliver accurate results and high throughput, their operation and maintenance require the continuous attention of skilled technicians. Attempts to adopt these technologies in POC environments have achieved only limited success. Footprints and costs have gone down, but sensitivity and complexity have remained the same.
However, innovative technology is changing that paradigm. Using portable devices equipped with disposable cartridges that include all necessary reagents and require no calibration or maintenance, clinicians can now run accurate CBCs on-site in mere minutes. Lightweight and easy to use, the reagents and sample remain safely within the cartridge during and after measurement, preventing cross-contamination. They can be used almost anywhere with minimal training* to deliver accurate readings of 20 standard blood count parameters, with the clinical sensitivity of central lab analyzers. Cutting-edge machine-vision algorithms classify the cells, based on their morphology and staining properties, providing higher resolution and clarity of different pathologies.
Fighting AMR at the point of care
The capacity to conduct CBCs and other hematology analyses at the point of care is a true game-changer in medicine, saving patients, clinicians, and health systems significant time and expense. In addition, they enable accurate, real-time diagnosis of bacterial infections, preventing the inaccurate prescription of antibiotics and making a significant contribution to the global fight against antimicrobial resistance.
(*) Please note: training must be defined by local, state and federal regulations. In the USA, training is defined for CLIA moderate complexity devices.