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Multiplex Therapeutic Drug Monitoring by Isotope-dilution HPLC-MS/MS of Antibiotics in Critical Illnesses
Published on: August 30, 2018
Tackling antimicrobial resistance in people who are immunocompromised: leveraging diagnostic and antimicrobial
Catherine Liu1, Emily A Rosen1, Erica J Stohs2
1Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, WA, USA; University of Washington, Seattle, WA, USA.
Abstract:
Antimicrobial resistance (AMR) disproportionately affects people who are immunocompromised due to their frequent encounters with the health-care system and repeated, prolonged exposure to antibiotics. AMR threatens to undermine continued advances in cancer care, haematopoietic cell transplantation, and solid organ transplantation by severely restricting therapeutic options. The convergence of several factors in the diagnostic evaluation of infection among individuals with immunocompromising conditions contributes to excess and inappropriate antibiotic use. Diagnostic and antimicrobial stewardship are key complementary strategies to address these challenges with shared goals of improving patient outcomes, reducing harm, and mitigating the risk of AMR. In this Series paper, we discuss opportunities to enhance use of existing diagnostic tools (eg, culture-based diagnostics, molecular diagnostics, and other tools such as antibiotic allergy delabelling), emerging diagnostic tools (eg, metagenomic sequencing and host response profiling), and digital innovation, to optimise antibiotic use, and the potential for precision medicine approaches to combat AMR in people who are immunocompromised.
Insights
Antimicrobial resistance (AMR) severely impacts immunocompromised patients, threatening critical medical advances. Optimizing diagnostics and antibiotic stewardship is crucial to improve outcomes and combat AMR.
Area of Science:
- Infectious Diseases and Microbiology
- Oncology
- Immunology
Background:
- Antimicrobial resistance (AMR) poses a significant threat to immunocompromised individuals, particularly those undergoing cancer care or transplantation.
- Frequent healthcare system encounters and prolonged antibiotic exposure exacerbate AMR risk in this vulnerable population.
- Limited therapeutic options due to AMR jeopardize advancements in life-saving treatments.
Purpose of the Study:
- To explore strategies for optimizing antibiotic use in immunocompromised patients.
- To highlight the role of diagnostic tools and antimicrobial stewardship in combating AMR.
- To discuss emerging technologies and precision medicine approaches for AMR mitigation.
Main Methods:
- Review of existing diagnostic tools, including culture-based and molecular diagnostics.
- Exploration of emerging diagnostic technologies like metagenomic sequencing and host response profiling.
- Discussion of digital innovation and precision medicine in the context of AMR.
Main Results:
- Current diagnostic evaluations contribute to excess and inappropriate antibiotic use.
- Enhanced use of both existing and emerging diagnostic tools can optimize antibiotic prescribing.
- Integrated diagnostic and stewardship approaches are essential for patient care and AMR control.
Conclusions:
- Diagnostic and antimicrobial stewardship strategies are complementary and vital for managing AMR in immunocompromised patients.
- Leveraging advanced diagnostics and precision medicine offers promising avenues to combat AMR.
- Improving patient outcomes and reducing harm are achievable through optimized antibiotic use.
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