New Opportunities for Microbiology Labs to Add Value to … · 2017-04-28 · threats in the US....
Transcript of New Opportunities for Microbiology Labs to Add Value to … · 2017-04-28 · threats in the US....
© 2017 BD. BD, the BD Logo and all other trademarks are property of Becton, Dickinson and Company.
Patrick R. Murray, PhD Senior Director, WW Scientific Affairs
New Opportunities for Microbiology Labs to Add Value to Antimicrobial Stewardship Programs
© 2017 BD. BD and the BD Logo are trademarks of Becton, Dickinson and Company. 2
Microbiologists and physicians were asked in a recent survey to name the most significant changes in microbiology in the last 10 years. The most common answers were:
– Evolution and global spread of multidrug-resistant bacteria, mycobacteria, and fungi
– Rapid adoption of molecular tests in infectious disease diagnostics – Use of MALDI mass spectrometry for identification of bacteria,
mycobacteria, yeasts, and molds – Introduction of whole lab automation in clinical microbiology – Rapid development of the field of the human microbiome
For the purposes of this discussion, we will not address the topic of the human microbiome although it is likely to impact future diagnostics and therapeutics.
Introduction
© 2017 BD. BD and the BD Logo are trademarks of Becton, Dickinson and Company. 3
Deaths attributable to AMR every year Compared to other major causes of death
“Global deaths due to AMR are projected to rise from 700,000 to 10,000,000 per year by 2050 if immediate action is not taken”
“Deaths due to AMR will be disproportionately weighted towards Developing countries due to healthcare infrastructure and resource availability”
Antimicrobial Resistance (AMR)
© 2017 BD. BD and the BD Logo are trademarks of Becton, Dickinson and Company. 4
In 2013, the CDC published a list of 18 drug-resistant threats in the US. • Urgent threat –
– Carbapenem-resistant Enterobacteriaceae (CRE)
• Serious threat – – Multidrug-resistant Acinetobacter baumannii (MDR) – Multidrug-resistant Pseudomonas aeruginosa (MDR) – ESBL-producing Enterobacteriaceae (ESBL) – Methicillin-resistant Staphylococcus aureus (MRSA) – Vancomycin-resistant Enterococcus (VRE)
In February 2017 WHO announced a list of 12 antibiotic-resistant “priority pathogens”: • Critical threats –
– Acinetobacter baumannii: carbapenem-resistant (CRAB) – Pseudomonas aeruginosa: carbapenem-resistant – Enterobacteriaceae: carbapenem-resistant, ESBL
Antimicrobial Resistance
© 2017 BD. BD and the BD Logo are trademarks of Becton, Dickinson and Company. 5
Antibiotic Resistance
© 2017 BD. BD and the BD Logo are trademarks of Becton, Dickinson and Company. 6
Global Prevalence ESBL CTX-M Strains
Resistant to all penicillins and cephalosporins
© 2017 BD. BD and the BD Logo are trademarks of Becton, Dickinson and Company. 7
Carbapenem Resistance NDM KPC
VIM OXA
Resistant to all beta-lactam antibiotics (penicillins, cephalosporins, carbapenems)
© 2017 BD. BD and the BD Logo are trademarks of Becton, Dickinson and Company. 8
Dates of Antibiotic Discovery: 30 Years with No New Classes of Antibacterials
© 2017 BD. BD and the BD Logo are trademarks of Becton, Dickinson and Company. 9
Future of Diagnostic Microbiology
© 2017 BD. BD and the BD Logo are trademarks of Becton, Dickinson and Company. 10
© 2017 BD. BD and the BD Logo are trademarks of Becton, Dickinson and Company. 11
MALDI-TOF Mass Spectrometry Vitek MS BD Bruker Biotyper
0
1000
2000
3000
4000
5000
4000 4500 5000 5500 6000 6500 7000 7500 8000 m/z
© 2017 BD. BD and the BD Logo are trademarks of Becton, Dickinson and Company. 12
• MALDI is less expensive - replaces all identification tests with decreased consumable supplies, QC tests, repeat testing and supplemental tests
• MALDI is more accurate - analytical sensitivity equivalent to sequencing 100s of genes so accuracy nearly 100%
• MALDI improves workflow - anaerobes identified as easily as aerobic bacteria with no special procedures such as subcultures, spot biochemical tests, chromatography
• MALDI is rapid - definitive identification of yeasts, molds and mycobacteria the same day growth is detected
• MALDI offers clinical value - blood culture isolates identified within 1 hour of detection
MALDI: Workflow Impact
© 2017 BD. BD and the BD Logo are trademarks of Becton, Dickinson and Company. 13
Molecular Carbapenemase Assays for Screening for Carriers
Check-Direct CPE assay for BD MAX: • KPC – 17 variants • NDM – 10 variants • VIM – 37 variants • OXA – 9 variants
Cepheid Carba-R for GeneXpert: (number of variants detected not specified) • KPC • NDM • VIM • OXA • IMP
© 2017 BD. BD and the BD Logo are trademarks of Becton, Dickinson and Company. 14
Molecular Identification/ Resistance Markers
Assay Number of Analytes
ID AST
>90 mecA, vanA, vanB
24 mecA, vanA/B, KPC
22 mecA, vanA, vanB, IMP, KPC, NDM, OXA, VIM
© 2017 BD. BD and the BD Logo are trademarks of Becton, Dickinson and Company. 15
Genotypic Tests Phenotypic Tests
Molecular Diagnostics (Rule Out)
HOSPITAL FORMULARY
Antibiotic 1
Antibiotic 2
Antibiotic 3
Antibiotic 4
Antibiotic 5
Antibiotic 6
Antibiotic 7
Phenotypic Susceptibility
Tests (Rule In)
Genotypic Tests – Predicts what Antibiotics Can’t Be Used (Resistance)
Phenotypic Tests – Predicts which Antibiotics Can Be Used (Susceptibility)
© 2017 BD. BD and the BD Logo are trademarks of Becton, Dickinson and Company. 16
Phenotypic Antimicrobial Susceptibility Tests
BD Phoenix bMX Vitek 2 Beckman Coulter MicroScan
© 2017 BD. BD and the BD Logo are trademarks of Becton, Dickinson and Company. 17
Total Lab Automation
© 2017 BD. BD and the BD Logo are trademarks of Becton, Dickinson and Company. 18
• Why would you want to automate historical inefficiencies?
• Think of lab automation as not automating what we do today but allowing us to do things we cannot do today!!
• Lab automation requires a cultural change for the benefits to be realized.
The Future is Defined by Innovative Thinking
Think Differently!
© 2017 BD. BD and the BD Logo are trademarks of Becton, Dickinson and Company. 19
Optimized Image Acquisition Poor SNR
Optimized SNR
© 2017 BD. BD and the BD Logo are trademarks of Becton, Dickinson and Company. 20
A change is needed if microbiology is going to be clinically relevant for patient care: we need to be patient focused!!
Microbiology Laboratory
© 2017 BD. BD and the BD Logo are trademarks of Becton, Dickinson and Company.
Thank you!
21