One of the most dangerous medical threats now facing us is the growth of resistance to antibiotics. According to the CDC’s 2013 report on antibiotic resistance, more than 2 million people in the USA every year acquire a bacterial infection that is resistant to antibiotics and 23,000 people die from these infections. Resistance arises when the bacteria, virus or other infecting agent changes or alters itself so that it is no longer susceptible to the killing effects of the antibiotic, i.e. the antibiotic no longer works to treat the infection.
Over the past few decades, many new and novels antibiotics were developed. Perhaps, this has made us passive to the threat. The growth of new anti-microbial agents has greatly slowed down. And the older ones are not working as well. Resistance is maximized through inappropriate use of antibiotics: when they are used and not needed or when they are used not as directed (often the complete course is not finsihed). Additionally, not having rigid infection control measures in place also aids in the emergence of resistance. Hand washing seems such a simple task and can have a profound effect. Yet, studies show that it is not being done as it should be.
The CDC has listed the following pathogens as urgent or serious threats because of their rising levels of antibiotic resistance:
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– Clostridium difficile
– Carbapenem-resistant Enterobacteriaceae (CRE)
– Drug-resistant Neisseria gonorrhea
– Multidrug-resistant Acinetobacter
– Drug-resistant Campylobacter
– Fluconazole-resistant Candida (a fungus)
– Extended spectrum -lactamase producing Enterobacteriaceae (ESBLs)
– Vancomycin-resistant Enterococcus (VRE)
– Multidrug-resistant Pseudomonas aeruginosa
– Drug-resistant Non-typhoidal Salmonella
– Drug-resistant Salmonella Typhi
– Drug-resistant Shigella
– Methicillin-resistant Staphylococcus aureus (MRSA)
– Drug-resistant Streptococcus pneumonia
– Drug-resistant tuberculosis
Recent increases in the availability of point of care testing has reduced the burden of patients requesting unnecessary antibiotics. When I do a rapid strep throat culture in the office and can show the patient it is negative, I can reassure the patient that the antibiotics are truly unnecessary. The same holds true for rapid influenza testing. Not only can point of care testing reduce unnecessary prescriptions for antibiotics but it can also cut costs.
The shift in healthcare these days is in prevention and early detection of diseases. The earlier detection happens, the easier and least costly the treatments.
Point of care testing (POCT) comprises several modalities. Most are relatively inexpensive, portable, standalone devices. They give immediate results, as opposed to the same tests being sent out to the labs and taking a few days to have the results return. These tests can work with blood samples, throat or nasopharyngeal swabs or other specimens depending on the test being done. These results can allow an immediate treatment decision to be started, whether for initiating treatment or observation only. They make our decisions more accurate and eliminate some unneeded medical therapies, which are not without side effects.
In order for a POCT to be truly beneficial, it should possess the following characteristics:
-be portable and be easy to be done in the exam room or at the patients’ bedside.
-be relatively inexpensive.
-produce results quickly.
-be as sensitive and specific as possible.
-yield usable data that allows physicians to make an immediate treatment determination.
While there are few point of care tests available today to detect or eliminate diagnosing specific infections, the potential to develop more is huge. If we can develop specific POCT for a multitude of infectious diseases, we can detect them earlier, treat more appropriately and ultimately slow the spread of infection by proper diagnosis and counseling. Additionally, we can preserve the antibiotics we have available today for true infections. Instead of spending additional money into discovering state-of-the-art antibiotics, perhaps the money would be better spent on developing more efficient and sensitive point of care testing.
