WHO report sounds an alarm for physicians and laboratorians worldwide 

Interview by Steve Halasey 

James Cottam, PhD

James Cottam, PhD

A recent report by the World Health Organization (WHO) has sounded an alarm for the international health community with findings that every region of the world is headed rapidly toward a “post-antibiotic era,” in which even common infections and minor injuries can kill. The culprit and focus of the WHO report is the rapidly increasing global incidence of antimicrobial resistance—including antibiotic resistance, when bacteria change so that antibiotics no longer work in people who need them to treat infections.

To find out more about the relationship between clinical diagnostics and the battle to halt the progress of antimicrobial resistance, CLP spoke with James Cottam, PhD, global product manager for antimicrobial stewardship and healthcare-associated infections at Alere, a leader in near-patient rapid diagnostics. In 2013, Cottam worked with the Alliance for the Prudent Use of Antibiotics to help launch “Test Target Treat,” an initiative to educate physicians on the role of rapid diagnostics in enabling improved treatment decisions as a way to combat the antibiotic resistance crisis.

CLP: The findings of the recent WHO report suggest that the arrival of a global “post-antibiotic era” is imminent. How would you assess the past and current pace of this problem’s spread?

James Cottam, PhD: The WHO report is very welcome as it draws awareness to the pressing issue of antimicrobial resistance. The problem has been escalating for years, but only recently has the wider global community become more aware of the problem. Resistance is spreading quickly at a time when new drugs are scarce. We are at a point where we need effective and coordinated action globally to overcome this threat to public health. At Alere, we believe that rapid diagnostics are critical to this approach.

CLP: What is the first line of defense against the continued spread of antibiotic resistance? 

Cottam: There are many practices that can help defend against the spread of antibiotic resistance. Probably the most important is the prudent and appropriate use of the antibiotics we have at our disposal today. There are many ways to achieve this, including education of both the public and healthcare providers, surveillance programs, and the use of rapid diagnostic tests to enable targeted antibiotic usage. Further, the development of new antimicrobials is important, and we must strive to use them judiciously in order to preserve their impact in the future.

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CLP: Do clinical laboratory diagnostics and point-of-care tests play different roles in monitoring antibiotic resistance and diagnosing the status of individual patients? 

Cottam: Both laboratory and point-of-care diagnostics are critical if we are to achieve effective diagnosis, monitoring, and treatment of antibiotic resistant organisms. Professionals in both of these areas should work together to maximize their impact. The skills and expertise of laboratory personnel, for instance, can be very effective in the implementation and support of point-of-care diagnostics in a variety of settings.

CLP: How can laboratorians and physicians best coordinate their use of diagnostic tools? 

Cottam: Communication is key between the laboratory and the physician to coordinate the use of diagnostic tools. Education from both sides on their respective areas can help to facilitate this, and I see a real need for cross-disciplinary specialists in healthcare settings to make this possible. In some countries, for example, antimicrobial pharmacists (sometimes called infectious disease pharmacists) are now common. Certainly all disciplines need to work together in diagnostics, and I am very pleased that we can offer educational materials through Alere’s “Test Target Treat” campaign to assist in this vital area.

CLP: The US Department of Health and Human Services and the European Commission recently released a progress report of the Transatlantic Taskforce on Antimicrobial Resistance (TATFAR) from 2011 through 2013. How would you assess TATFAR’s activities specific to clinical laboratory testing?

Cottam: The TATFAR collaboration is an excellent initiative to coordinate efforts between the European Union and the US on antimicrobial resistance. The group discusses the impact of rapid diagnostics in its May 2014 report, but rapid diagnostics should receive a greater focus—especially in relation to the responsible use of existing antimicrobials. While there clearly needs to be a focus on new antimicrobial discovery—and this is well covered in the TATFAR report—unless new drugs are used responsibly and appropriately, then resistance to these new compounds will be swift and inevitable. Rapid diagnostics play a key role in the judicious use of antibiotics, both new ones as well as those currently available.

CLP: Around the world, how are diagnostic outcomes presently communicated to public health authorities? Are better methods needed?

Cottam: There are some great examples of effective monitoring and reporting of diagnostic outcomes to public health authorities from around the world. In the UK, for example, reporting of healthcare-associated infections such as methicillin-resistant Staphylococcus aureus (MRSA) and C. difficile is mandatory. Understanding and applying effective examples from countries around the world is an essential step, but we would also like to see a more-connected approach both nationally and internationally. There is a lot of room for improvement in current methodologies in all countries, and new technologies and approaches are now available to facilitate this.

CLP: In what ways might better diagnostic tools improve the public health response to this impending crisis?

Cottam: Better diagnostic tools can have a massive impact on the public health response to the resistance crisis. In particular, rapid, near-patient, or point-of-care diagnostics can help the patient better understand their own health—including when an antimicrobial intervention is likely to have an impact and when it won’t. It is clear that a significant percentage of antibiotic prescriptions are unnecessary, and public understanding of when they should be utilized is often poor. For example, antibiotics are not effective against viruses, which are responsible for a large number of respiratory infections. A great example of diagnostic tools in action is the widespread use of C-reactive protein point-of-care tests by doctors in some European countries. It is well documented that in these same counties, rates of antibiotic resistance are low and public understanding of appropriate antibiotic use is much higher than in countries that do not use this diagnostic tool.

CLP: What more can laboratorians do to prevent the onset of a “post-antibiotic era”?

Cottam: Laboratorians can play a significant role in combatting the antibiotic resistance crisis. Their skills and expertise are vital to the success of any approach to this public health crisis. Laboratories need to be open-minded to new diagnostic solutions—especially those deployed outside the lab at the point of care—and consider what is best for the patient and public health in general. We would like to see the laboratory play a central role in supporting point-of-care diagnostics in healthcare settings, to ensure that a high-quality solution can be delivered quickly and have the maximum impact to limit and prevent the spread of resistance. n

Steve Halasey is the chief editor of CLP.