The fight against antimicrobial resistance

The impact of sepsis can be devastating for patients and their loved ones. The WHO reports that, in 2017, there were almost 50 million cases of the condition, resulting in 11 million sepsis-related deaths worldwide. At a time when the world is watching in horror at the growing number of deaths associated with Covid-19, those figures are staggering.

It isn’t just the number of deaths we should, collectively, be fearful of; for patients lucky enough to survive the condition, long-term impacts can last many more years.

“What we know from people who have survived sepsis over the last couple of decades is that for seven years after the index episode, there’s an increased risk of further admission with bacterial infection,” explains Dr Ron Daniels BEM, executive director of the UK Sepsis Trust and vice-president of the Global Sepsis Alliance.

Both recognising the symptoms and diagnosing the condition quickly are critical to the chances of survival. Faced with the possibility of waiting up to three days for a lab to confirm the pathogen causing the condition means the initial standard of care (SoC) treatment approach is to deliver broad-spectrum antibiotics. “The unmet need, therefore, is to have rapid point-of-care diagnostics to help guide clinicians as to which antibiotic to select so that we can be a bit more judicious in our choice, and, in turn, cause less selection pressure for antibiotic resistance,” Daniels says.

While using broad spectrum antibiotics is a key therapeutic strategy to treat severe infections, the benefit of being able to identify the pathogen and its susceptibility profile early on in the clinical pathway will allow for a more tailored treatment regimen, ultimately benefitting patients’ short and longterm prognoses. The other challenge of using broad-spectrum antibiotics is the potential for antimicrobial resistance.

Q-linea is committed to ensuring that antibiotics continue to be effective, helping to treat future generations without advancing the risk of resistance. Part of doing that is being able to identify pathogens through rapid antibiotic susceptibility testing (AST). Q-linea develops products that enable clinicians to determine the right antibiotics early on, individualising the treatment a patient receives and, ultimately, curbing the duration of the broad-spectrum approach that has been the SoC for decades, reducing the potential for antibiotics to be overused and, thus, the risk of driving antimicrobial resistance.

Bespoke service

Individualising antibiotic treatments is becoming even more possible thanks to the use of minimum inhibitory concentration (MIC) techniques in determining the exact dosage to inhibit pathogen growth. Daniels that says, in the past, antibiotic prescribing has been done “quite naively” according to the patient’s individual characteristics, particularly their body weight.

“We need to tailor the therapy to the individual patient’s needs and understand not only what effective MIC is [required] against a particular pathogen, but also in the individual patient: what dose, what route of administration, what frequency of administration do we need to achieve that MIC?” he says.

Rapid AST is a technology that has the potential to dramatically change the treatment of sepsis. Daniels says even for patients that begin with SoC, he can imagine a situation where, by the second dose 12 or even eight hours later, pathogens have already been identified and treatments are personalised. Its importance has been further emphasised during the Covid-19 pandemic.

Secondary fear

The lines between the virus and sepsis are blurred, Daniels says, with patients treated in secondary care for viral sepsis too. Hospitals have commonly prescribed antibiotics in case patients have a secondary bacterial infection. “The pandemic has taught us that we need to get much more intelligent at our decision making in terms of who needs antimicrobials,” he adds. “It is about rapid pathogen diagnostics and other biomarkers that can help us to guide decision making.”

The company’s CEO, Jonas Jarvius, says, “Q-linea’s unique system for rapid and fully automatic AST analysis has the potential to greatly improve and speed up the diagnosis for patients with severe infectious diseases such as sepsis. We are looking forward to a commercial launch as soon as the ongoing clinical study is finalised and ASTar is CE-IVDapproved.” The future of rapid AST is an exciting and potentially transformative one as companies like Q-linea continue to innovate.