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Subspecialties Bioinformatics, Clinical care, Digital and computational pathology, Technology and innovation, Microbiology and immunology

Resigned to Resistance?

As every pathologist knows, the path from patient presentation to recovery should be a simple one: first, diagnosis; next, treatment; and, ultimately – hopefully – a resolution. But it’s not always that easy, even when the first step is relatively straightforward. In some situations, there simply isn’t time to conclusively identify the microorganism or pathogen causing the infection before treatment. In these cases, patients are given broad-spectrum (or even incorrect) antibiotic treatments, which can slow down the recovery process or contribute to the growing threat of antimicrobial resistance (AMR). But if patients can’t wait for therapy, how can we avoid such situations? By reducing the turnaround time from sample collection to final result of the pathogen identification and antibiotic susceptibility – and here, technology-driven workflows, especially those incorporating lab automation and integrated informatics, can help.

Accurate and timely diagnosis drives the patient’s treatment in a much more effective and efficient manner. But it’s not always easy. Perhaps the best example is provided by the case of sepsis, where patients may display severe symptoms very quickly. There may not be sufficient time to identify the exact causative pathogen and its potential resistance mechanisms. Therefore, clinicians administer broad-spectrum antibiotics as soon as possible, followed by a more targeted drug once diagnostic results are in.

Accurate and timely diagnosis drives the patient’s treatment in a much more effective and efficient manner. But it’s not always easy.

By reducing turnaround time – while maintaining the high level of diagnostic accuracy we need to help drive accurate therapy decisions – we can start to move away from guess work in antibiotic use. This would not only be more responsible from an AMR stewardship point of view, but would also allow us to tailor treatments to a specific pathogen and any resistance genes it possesses.

What causes diagnostic delays? Well, a combination of factors – including logistical challenges, and assay setup and execution – but it’s the pre- and post-analytical phases that are in most need of optimization. Here, I believe that better process mapping and definition, combined with new and improved informatics can make a real difference. For example, the delay between obtaining a result and transmitting it to the appropriate clinician is a significant obstacle that can be surmounted with integrated informatics.

Most microbiology labs are in acute care hospitals or reference laboratories, with many operating 24/7. But what good is a rapid result if it doesn’t reach the clinician quickly enough to make a difference? Integrated informatics – such as automated result reporting or sentinel reports – will play a big role in speeding up processes and potentially minimizing treatment delays.

Lab automation and technology-based solutions can truly streamline the pathway from sample received to reporting results. To explore those options, though, laboratories need to commit to investing resources. The biggest challenge I see? The change management so often required to implement these end-to-end processes. As you implement innovations, technology is just one component of the total solution – you need to select an industry partner who not only has the best product for your needs, but also the right clinical expertise, robust training programs, and change management programs that meet a lab’s specific needs and requirements… in short, all the support you need to integrate new technology into your laboratory workflow. Once the technology is installed, a good partner will also continue working with you on continuous improvement. Transitioning to a new, more automated or technology-based workflow isn’t just a single event; it’s an ongoing process involving a commitment on both sides.

We have worked in partnership with laboratories around the world, transforming microbiology from a labor-intensive, error-prone manual process to an integrated, automated one. In doing so, we may be able to shorten the time to result – which can enable faster and more targeted treatment, thereby reducing length of stay, improving antimicrobial stewardship, and potentially lowering overall costs.

Gains can be made not only in the analytical phase of testing, but also in the pre- and post-analytical phases, where we can ensure the correct test is applied to the correct sample, and results are returned to the correct physician as quickly as possible.

In my opinion, it is absolutely crucial that healthcare systems recognize the value of diagnostics; after all, they are very effective tools to both reduce the cost of healthcare and helps improve patient outcomes. We must also recognize that these goals can be accomplished through the evolution of – and investment in – innovative technologies in microbiology, molecular, lab automation, and an integrated informatics solution.

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About the Author
Steve Conly

Steve Conly, Vice President and General Manager of Microbiology at BD (Becton, Dickinson and Company), Sparks, MD, USA

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