Combating antibiotic resistance: One step ahead through technology

Antibiotic resistance is on the rise in all parts of the world, complicating medical treatment of serious bacterial infections in patients. The World Health Organization estimates that approximately 33,000 people die each year from antibiotic-resistant bacteria in Europe alone. Bacteria that are resistant to multiple or even all known antibiotics pose an ever-increasing threat.

Physicians and health organizations already warn of an impending post-antibiotic era: If the trend of antibiotic resistance continues, we will reach a point where bacterial infections can no longer be treated with antibiotics. Many factors contribute to the development of antibiotic-resistant bacteria, such as the use of antibiotics in livestock and fish farming, unnecessary prescriptions for antibiotics written in doctor’s offices or misuse by patients. To reduce or stop the spread of antibiotic-resistant bacteria, it is critical to only use antibiotics when they are truly needed. To support this cause, the WHO has recently published guidelines on the use of medically important antibiotics in food-producing animals, as well as a list of critically important antimicrobials related to human medicine. The organization has also recently launched the "AWaRE" campaign.

Patients in hospitals and nursing homes are at a higher risk of antibiotic-resistant infections. If the staff does not adhere to strict hygiene and isolation precautions, infections can easily spread to other patients. Oftentimes, patients with a weak immune system are no longer able to fight off an infection. In the worst-case scenario, it can cause sepsis, a serious medical condition that can result in organ damage or death if there is no quick treatment. The use of antibiotics is inevitable, but might sometimes prove unsuccessful.

Nowadays, the pharmaceutical industry rarely researches new antibiotics because the clinical development takes a long time and is very costly, while resistances can develop very quickly. That’s why clinical measures must be improved to preserve the effectiveness of existing antibiotics, prevent the development of resistances and combat antibiotic-resistant bacteria. Laboratory tests are the frontline defense for an existing infection. They identify the bacteria and antimicrobial resistance. These methods are referred to as phenotypic drug resistance testing: if a bacterial culture is able to survive and grow in the presence of one or more antibiotics, it indicates resistance, prompting the need to find another active ingredient.

"The drawback is that this test takes quite a long time, often between 16 and 48 hours," says Prof. Axel Hamprecht in an interview with MEDICA-tradefair.com. This is where diagnostic tests come into play as they rapidly provide answers with little effort. Hamprecht and his research group at the University Hospital Cologne have developed a test that detects bacteria that are resistant to the carbapenems class of antibiotics. These are enzymes that inactivate carbapenems, a class of the most effective last-resort antibiotics. "It works faster than phenotypic drug resistance testing. Our test allows us to identify carbapenemases within half an hour," explains Hamprecht.

The researchers from Cologne did not develop the actual rapid test but set up a rapid test process based on a commercially available, immunochromatographic assay. These types of tests are increasingly important as more and more people travel around the world along with resistance mechanisms. Carbapenem-resistant Enterobacteriaceae (CRE) are presently on the rise in Western and Central Europe for example.

The InfectoGnostics Research Campus in Jena develops a device-based test procedure that uses Raman spectroscopy. The Campus is a public-private partnership that enables close collaboration between researchers from the fields of medicine, sciences, and industry. During the next five years of funding, the scientists focus on testing methods that diagnose pneumonia bacteria in immunosuppressed patients. "We illuminate the bacteria with laser light - once without antibiotics and once with antibiotics in different concentrations - and analyze the backscattered light," says Prof. Jürgen Popp, Member of the Executive Board and Campus spokesperson in an interview with MEDICA-tradefair.com. An algorithm is used to detect characteristic fingerprinting patterns in the spectrum of backscattered light, which point to molecules present in the bacteria, indicating possible resistance mechanisms.

Prof. Mathias Pletz of the University Hospital Jena adds: "Physicians urgently need advances in diagnostics. Without accurate pathogen detection, we might mistreat the patient and – in the worst-case scenario - cause his death." The public-private partnership provides a key advantage in this setting: physicians are in touch with industry developers right from the start. This ensures that their needs and requirements promptly flow into the product development process, allowing them to ultimately have a testing system that is cost-effective and can easily be integrated into clinical practice.

Rapid tests are just one component in the overall strategy to combat antibiotic-resistant bacteria. Ideally, hospitals should use technology that defends against bacterial infections and prevents the need for antibiotics. This is not just a question of hand hygiene and surface disinfection or sterile processing. The war against bacteria already starts with materials used for hospital construction and equipment. Copper and silver have an antibacterial effect by releasing ions that kill germs. Copper can be used as a material for door hardware and similar items, while silver works well as an ingredient in wound dressings.

Functionalized surfaces also attack and fight bacteria (read more about this at COMPAMED-tradefair.com). Some approaches include nanosized structures that damage the cell membrane of the pathogens on contact, which subsequently destroys them. This process lends itself to large-scale areas such as floors, walls, and furnishings. Currently, cleaning and disinfection of these surfaces is very cumbersome. Implant surfaces can also be functionalized using antibiotics, which are gradually released during the first few weeks after implantation.

All of these examples show how technology supports the fight against antibiotic-resistant bacteria. Proper and targeted antibiotic usage will continue to be the most important step in this endeavor. Having said that, the right combination of rapid diagnostic tests and actions that promote and enhance hospital hygiene could be instrumental in preserving the effectiveness of available antibiotics in the future.