Lab Innovations Empower Clinicians in the Fight Against Antimicrobial Resistance

Speed of response is critical when managing patients with suspected infectious disease, but a challenge often experienced with standard culture-based methods is longer turnaround time. This means empirical antimicrobial therapies may be initiated based on early medical assumptions, perpetuating resistance if an antibiotic was misused. Could microbiology labs help change the habits of providers using frontline broad-spectrum antibiotics as a catchall solution?

Dr. Jim Dunn, director medical microbiology and virology at Texas Children's Hospital in the United States believes a laboratory should be equipped to “provide information that allows [clinicians] to de-escalate antibiotic therapy for individual patients and hopefully over time, that will decrease utilization of those empiric broad-spectrum antibiotics.”

The last few decades have seen significant advancements in laboratory technology that have greatly improved the understanding and management of AMR. Culture-based diagnostics remain a valued standard, particularly for low-to-middle income countries where access to resources is limited.  These methods provide reliable results but can be time-consuming and labor-intensive.

In higher-come countries, automated commercial platforms are being utilized to improve time to result and laboratory efficiency. Automated antibiotic susceptibility tests (AST) help reduce time to microbial identification and resistance mechanism detection. Microbiology labs equipped with automated systems can now provide results from bacterial colony growth as well as direct from sample tests – including blood, cerebrospinal fluid, stool, and respiratory samples, and they can do it in hours rather than days. This rapid turnaround supports clinicians in personalizing patient therapy sooner and reducing unnecessary use of antibiotics.

More sophisticated technologies such as molecular diagnostics have also emerged in recent years. Multiplex polymerase chain reaction (PCR) for example, can provide multiple answers from a single blood culture in a short period time—distinguishing what bacteria is making a patient sick and identifying antimicrobial-resistance genes. With results in some applications available in ~15 minutes to ~1-hour, this suggests that laboratories could improve productivity and potentially reduce costs with PCR technology.

Dzoara Lugo, corporate manager of epidemiology and infection control at Christus Muguerza in Mexico, points out that the value of diagnostic solutions like PCR, extend beyond per patient value. “Identification of the resistance mechanisms of the different microorganisms is very important in order to improve the clinical results of the patients, but also to identify how [they] are behaving, where these microorganisms appear, how is the dissemination of this resistance, and if there is any outbreak,” Lugo said.

Beyond the growing adoption of technologies like PCR, other promising non-conventional diagnostic solutions are also being developed to help address the concerning emergence and reappearance of certain infectious diseases, such as whole genome sequencing (WGS), which can detect and predict AMR in microorganisms. Some WGS techniques use nanopore technology to analyze DNA molecules, helping to identify microbial communities and AMR determinants. Next-generation sequencing (NGS) has made WGS faster and more cost-effective, allowing for quicker impact on patient care. This technology can identify at-risk pathogens directly from clinical samples without traditional culturing methods. 

Advances in diagnostic technology are leading to a greater need and opportunity for collaboration between the laboratory and the clinician. A laboratorian can provide expertise in ordering the right test and ensuring the right interpretation, which has been coined as diagnostic stewardship. 

Diagnostic stewardship aims to improve the timely ordering, collection, processing, and reporting of diagnostic tests to improve patient management and slow the spread of AMR. The evolution of lab technology applied to the fight against AMR has been a crucial aspect of tackling this global health challenge — and it will continue to play an important role as time goes on.

Vital to innovation, whether technology, people or process – is collaboration, and when it comes to advancing antimicrobial stewardship (AMS) in healthcare systems, everyone has a role to play. AMS, like diagnostic stewardship, is focused on better patient outcomes. Integration of diagnostic stewardship from the laboratory with AMS on the clinical side, supports the right interpretation evolving into the right antimicrobial therapy. But AMS extends beyond even the healthcare professional, requiring the engagement of researchers, policymakers, and even the patient. 

The battle against AMR is rooted in the laboratory where technicians are arming clinicians with the tools and shared information they need for faster and more accurate diagnoses that can lead to more effective prescribing and better patient care. Dr. Linoj Samuel, division head of clinical microbiology, Henry Ford Health, in the United States confirms, “Our ultimate goal is not just improving time to result but showing that time to result translates to meaningful changes and improvements in patient care and outcomes.” As we continue to innovate and collaborate, we move closer to a world where AMR no longer poses a critical threat to global health.