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

Possibly influencing the range of antibiotic resistance genes seen by a GP within his/her practice is the fact that travelers (including holidaymakers, sales representatives, etc.), as well as patients undergoing surgery (including elective cosmetic surgery) may have recently visited countries with a high prevalence of antibiotic resistance, and subsequently become colonized with nonlocal antibiotic-resistant bacteria during their travels [27] . Examples of such nonlocal antibiotic resistances could include various ESBL [28] and New Delhi β-lactamase-1 (NDM-1) producing bacteria [29] . Additionally, communities containing relatively high levels of citizens from ethnic minority backgrounds may also show differences in the range of antibiotic resistances carried [30] . The question then for POC diagnostic innovators is 'how relevant are travel-and ethnic background-related antibiotic resistance in patients attending GP practices in different geographical locations?' Unfortunately, the specific collection of travel-and community-based antibiotic resistance data is likely to be too expensive for most POC diagnostic innovators. Important also to remember, is that once GPs start using 'stronger and more unusual' antibiotics against pathogens that have become resistant to the 'standard antibiotics' prescribed within general practice, the cryptic (asymptomatic) carriage of more unusual 'travel/ethnic background-associated' antibiotic resistances within the community setting could become important. In this scenario, the vertical transmission of such genes to related/unrelated bacterial species could also impact on the risk of infection by pathogens already resistant to previously used antibiotics. This in turn, could mean that, by the time POC developers place a diagnostic on the healthcare market (approximately 10 years), the antibiotic resistance problem may have changed from their original data.