Superbugs, Sepsis and Smart Antibiotic Stewardship

How Superbugs Can Drive Up Sepsis Rates – and How to Reverse the Trend

It's a disturbing dilemma: The more antibiotics are used, the less effective they become. That's why the careful stewardship of these precious medicines is especially important in health care settings, where hospital-acquired infections that often end up causing sepsis are a serious problem. "Antibiotics are lifesavers, but only if used judiciously," notes Dr. Matthew J. Bankowski, Ph.D., MS, D (ABMM), HCLD/CC (ABB), Clinical and Molecular Microbiology Laboratory Director, Baptist Medical Center, Jacksonville, Florida. While antibiotics, or antimicrobials, kill sensitive bacteria that cause illness, they can leave more fit, drug-resistant bacteria, if present, to grow and multiply. "The development of drug resistance does not ensure that resistant bacteria will thrive, so the making of a superbug is not an easy process," Bankowski notes. "But once a microbial 'monster' is strong, it is extremely difficult to control." Some bacteria have only one type of antibiotic left that will work against them. If a gene resistant to that antibiotic jumps to these bacteria, the result can be untreatable superbugs. "Unfortunately, the use of broad-spectrum antibiotics poses a toxicity threat to the patient and may even contribute to an individual's demise," Bankowski adds. In some cases, if the bacterial strain is not known, a patient may be treated with the wrong antibiotic, which further cultivates resistance. In other cases, antibiotics may be administered for longer than necessary. While bacterial resistance is growing, the number of new approved antibiotic medicines is declining. The proportion of certain bacterial strains that are resistant to antibiotics has increased steadily over the past 30 to 40 years, yet the number of new systemic antibiotics approved by the FDA has shrunk dramatically.1,2 At the same time, healthcare-associated infections, some of which advance to sepsis, continue to be a major threat to patient safety. Infections acquired in healthcare settings are the most frequent adverse events in healthcare delivery worldwide.3 In the fight against sepsis, GE Healthcare & Roche Diagnostics are collaborating to develop a solution to help address the urgent need for better antibiotic stewardship. "The plan is to develop a solution that features Roche diagnostic tools and GE Healthcare analytic capabilities in patient monitoring to help apply precision digital health that can facilitate ways to identify and treat the bacteria that are the focus of antibiotic stewardship programs," says Roche Diagnostics Information Solutions Partner Lead Bryan Cobb. One tool that's of enormous value to clinicians fighting infections is the antibiogram. Antibiograms are reports of which antibiotic-resistant bugs have been detected in the hospital. The antibiogram must be customized to each individual institution, because even nearby hospitals may have different resistance populations. Armed with this information, clinicians can choose antibiotics that are more likely to be effective for a patient and select the most appropriate antimicrobial treatment to start while awaiting culture results. But antibiograms are complex, expensive and time-consuming to generate. So, they aren't always used as routinely as they might be – such as in guiding hospital pharmacies to put the most effective antibiotics in on-floor mini-pharmacies so they're more accessible to patients, to enhance operational excellence. "GE Healthcare and Roche plan to integrate antibiogram information alongside clinically relevant information about the patient into our clinical decision support tool that can help describe the source and severity of a sepsis," Cobb says, "to streamline clinicians' access to these complex, valuable data. We want to put it right at their fingertips –integrated right into the care pathway – to help them make earlier, more informed decisions about selecting and continuing empiric antimicrobial therapy." “The early detection of sepsis has eluded us even with the most state-of-the-art biomarkers and diagnostics," Bankowski notes. "Sepsis is the primary cause of death in US hospitals and we desperately need a solution for early detection. I believe that the collaborative endeavor between diagnostic tools from Roche and analytic tools for patient monitoring from GE Healthcare can help with the early detection of sepsis.”  
  1. Cooper & Shlaes (2011). Nature 472:32
  2. Boucher et al (2013). Clin Infect Dis 56:1685–1694
  3. Health care-associated infections fact sheet, World Health Organization. Accessed 8/28/2018.