Challenges in identifying antibiotic resistance targets for point-of-care diagnostics in general practice

Mitsakakis, Konstantinos; Kaman, Wendy E; Elshout, Gijs; Specht, Mara; Hays, John P

The continued spread of antibiotic resistance is a global problem with the WHO predicting 10 million global deaths due to antibiotic resistance by 2050 [1, 2] . One way of helping defeat the emergence of antibiotic resistance is via the accurate prescribing of antibiotics only to those patients who are suffering from bacterial (instead of viral) infections. The problem of accurate antibiotic prescribing is especially relevant for general practitioners (GPs) [3, 4] . GPs stand on the front line of patient care (primary care), most often being the first point of contact between medical specialists and the general public. However, the rapid differentiation between a bacterial and viral infection in primary care patients is especially difficult to achieve, since the patient's history and physical examination have only a limited value in differentiating between a viral and a bacterial infection [5, 6] . Further, if specimens are sent to a centralized diagnostic laboratory for traditional 'gold standard' testing, the results of pathogen isolation, identification and antibiotic resistance detection may take several days to arrive back at the GP practice. Taken together, this means that accurate, evidence-based diagnosis and targeted antibiotic prescribing by GPs are currently problematic. One possible approach to this problem is to implement so called point-of-care (POC) diagnostics at the GP practice and many different POC diagnostics are currently available, or are being developed, to detect infectious diseases [7] . These POC diagnostics can be generally divided into three 'classes': POC diagnostics that differentiate between bacterial and viral infections (without defining which pathogen is present), for example, diagnostics based on inflammatory biomarkers; POC diagnostics that detect and report a specific pathogen that may be present, but (in case of a bacterial infection) do not provide information on the presence of antibiotic resistances, for example, diagnostics based on nucleic acid amplification techniques; and POC diagnostics that detect and report a specific pathogen and the presence of antibiotic resistance, for example, diagnostics based on nucleic acid amplification techniques coupled to microarrays. The ability to accurately differentiate between a viral and bacterial infection may help enormously in reducing the amount of unnecessary antibiotics prescribed to patients suffering from viral infections. This may Table 1 . Potential problems and possible solutions to choosing antibiotic resistance targets for incorporation in point-of-care diagnostics for use by general practitioners.