What next for rapid AST?

A recent visit to ECCMID (European Congress of Clinical Microbiology and Infectious Diseases ) in Amsterdam served to highlight a conundrum in the antimicrobial susceptibility testing  (AST) market.  On the one hand the market is served with hugely sophisticated, automated modular equipment, giving high throughput capability with time to result of 5-6 hours.  On the other hand, for local, ‘near patient’ AST there is virtually nothing available.  However, scratch the surface and there is an impressive amount of effort and resources being directed towards proving the capability of new technologies in this space.

There’s no doubt about it, the established players are chipping away at the time to result, increasing the throughput, and releasing new panels of antibiotics.  But the essential technology remains the same: waiting for the target organisms to show growth or not in the presence of an antibiotic.  High definition imaging, data analysis and futuristic levels of automation without question serve the high volume market extremely well.  But is this where the entire future focus of AST needs to be? 

In our collective efforts to deliver ever-better, more personalised patient care is a new approach to AST needed?  A smaller-scale, more rapid capability, able to provide clinically-relevant, diagnostically accurate and timely result in a manner not yet attainable?

If this is a worthwhile goal, then hope exists in abundance.  The breadth of technologies being explored is impressive – and importantly, is distinct from the existing mainstream ‘growth imaging’ approach.  Technologies ranging from microcalorimetry, though microcantilevers and on to sensing of volatiles – the shift is towards determination of metabolic activity rather then measuring ‘growth’ itself.  There is of course no guarantee any of these approaches will prove to have the characteristics required of a clinically-relevant rapid AST method, but it is encouraging that there is an active pipeline of methods under development. 

Like many of the exciting young companies at ECCMID, at Vitamica we believe that a rapid AST fit for use in near-patient settings has a role in future healthcare services.Indeed, it is difficult to see how the UK Government’s target for reducing antibiotic prescribing without diagnostic evidence of need or appropriateness can be met without small-scale, local AST provision. And we have not even touched on how the issue of unnecessary antibiotic use can be tackled in low-middle income countries. Is this where near-patient rapid AST will really come to the forefront?