The optimal use of antibiotics constitutes one of the cornerstones of effective antimicrobial stewardship and thus antimicrobial therapeutic intervention. It is for this reason that the pharmacist plays a key role in ensuring that pharmaceutical resources are used as optimally as possible to facilitate effective patient outcomes, within the constraints imposed by budgetary restrictions.
However, the task of the pharmacist is being made more challenging by the spread of antimicrobial resistance (AMR), which is compounded by the dwindling supply of new antibiotics. It is in the face of these more limited treatment options that pharmacists must ensure early, appropriate and effective antibiotic therapy for patients with critical infections, while avoiding overexposure to and unnecessary use of broad-spectrum antibiotics, in the face of evolving organism sensitivity profiles and lack of new antibiotics.
A growing awareness of these problems prompted the UK government to make the following recommendations in their recently published Five Year Antimicrobial Resistance Strategy.
“4.5 Indiscriminate or inappropriate use of antibiotics is a key driver in the spread of AMR. There is already an extensive range of guidance, education, tools and industry-sponsored initiatives to promote the responsible use of antibiotics in patients and animals, but most prescribing is carried out in the absence of adequate information about the nature of the infection or before the results of diagnostic testing are available.
4.6 Conserving the use of currently available antimicrobials is a vital part of antimicrobial stewardship. Whilst timely and appropriate treatment of probable bacterial infection is essential, we equally need to ensure use of the right drug, right dose at the right time and for the right duration to limit unnecessary antibiotic exposure.”
However, if the above criteria are to be met, a critical problem that needs to be resolved is that accurate species identification can take an additional 24-48 hours once a blood culture has flagged positive. In many cases a prescription will need to made based on a gram stain which can indicate the general direction of therapeutic intervention (as described in 4.5 above), pending a specific, positive species ID. However, this may still result in either the use of an inappropriate drug, or the undesirable use of a broad-spectrum antibiotic.
The QuickFISH system avoids these problems by allowing species ID to be reported at the same time as the gram stain result. This permits a species specific antimicrobial therapeutic strategy to be chosen, especially when dealing with microorganisms that share an identical morphology when viewed under gram stain. Examples of organisms with differing sensitivities that QuickFISH can distinguish include -:
*DATA SOURCE: Bassetti, M et al. Ann Clin Microbiol Antimicrob. 2013 Aug 28;12(1):22. doi:10.1186/1476-0711-12-22