F130 How Can We Optimize the Use of Antibiotics? (Oliver Schacht, OpGen)
It is terrifying to get an infection and run out of options to treat it. Existing antibiotics are and are going to keep losing their effectiveness if antibiotics and antimicrobials are not used effectively.
Antimicrobial Resistance (AMR) occurs when bacteria, viruses, fungi, and parasites stop responding to medicines. It's an old problem. "We're still diagnosing pathogens bacteria, essentially the same way we've been doing it for over 130 years. And that's by microbiology culture, which takes several days. Doctors today know that they will need to wait days before getting an answer as to the specifics of a bug that made a patient sick in their hospital. In the absence of diagnostic information, they treat patients empirically with their best judgment. That's usually by using broad-spectrum antibiotics. That compounds the problem of antibiotic resistance. Antibiotic resistance is bacteria trying to survive under the stress of antibiotic treatment," says Oliver Schacht, the CEO of OpGen - a software company that developed cloud-based software to identify, track, and predicts antibiotic-resistant infections.
Antimicrobial-resistant infections currently claim at least 50,000 lives each year across Europe and the US alone, with many hundreds of thousands more dying in other areas of the world, according to The Review on Antimicrobial Resistance, published in 2014.
While the numbers are concerning, antibiotics are not appealing to the pharmaceutical industry from a business perspective. New antibiotics are intended for a fraction of all patients, meant as the last resort for clinicians after they've tried all other options. This means that more often than not, clinicians would try to avoid using them to prevent antimicrobial resistance from forming for the innovative new antibiotics as well. "From a commercial standpoint, antibiotics are a lousy product. A company would usually get a couple of 100, maybe a few $1,000, for a course of antibiotics that you give to a patient over ten days, sometimes three weeks. After that, the patient is either dead or back home and healthy. Compare this to a cancer drug that is given for years and years. You're talking about hundreds of 1000s of dollars per patient. This is why, historically, the pharmaceutical industry has gotten out of developing antibiotics. We've been talking about creating government incentives to develop new antibiotics," mentions Oliver Schacht.
Oliver Schacht.
In 2019 WHO identified 32 antibiotics in clinical development that address the WHO list of priority pathogens. Only six were classified as innovative.
The key to improving the use of antibiotics is improved antimicrobial stewardship, and new technologies could play a role. OpGen developed cloud-based software to identify, track, and predict antibiotic-resistant infections based on genetic information.
Data and the fight against antimicrobial resistance
"Our datasets are based on more than 30 years of research on five continents and hundreds and hundreds of hospitals. We combined the data from two of the leading industry players, Merck pharmaceuticals on the one hand and Siemens on the other hand. They have spent decades collecting bacterial isolates around the globe, they have sequenced them, and then they've compared the sequence information to the antibiotic susceptibility or resistance. We've brought those databases together. Today have a data set that's roughly 55,000 different bacterial isolates that have not only all been sequenced, but they've also been phenotypically profiled against over 100 different antibiotics. This is the broadest and deepest combination of, you know, genetic information and phenotypic susceptibility or resistance information."
Rapid testing (not only by OpGen) is available; the not quite clear part is the reimbursement of the testing. The use of tests is determined based on the negotiations and sales of rapid diagnostics providers and individuals hospitals, says Oliver Schacht, the CEO of OpGen.
For improving antimicrobial stewardship globally, several things would need to be coordinated:
Databases about outbreaks and bugs becoming resistant.
Broadscale rapid diagnostics would need to be in place to detect the bugs and resistance.
Improved antimicrobial stewardship, so the antibiotics we use today will still work in 20 or 30 years.
Defined rapid diagnostics reimbursements schemes.
Defined incentives for the development of new antibiotics.
Tune in for the full discussion.
Questions addressed:
Why the use of antibiotics still very ineffective today? Let's talk about why broad-spectrum antibiotics are prescribed ineffectively - we still see too many over and undertreated patients? Can you also elaborate on how broad this issue is?
In 2019 WHO identified 32 antibiotics in clinical development that address the WHO list of priority pathogens, of which only six were classified as innovative. Why is developing antibiotics such an issue?
One would think that with the scientific and computing advancements, in-silico discoveries, and testing, we'll discover new antibiotics rather easily…?
700.000 deaths due to bacterial infection, 50.000 due to drug-resistant infections. To which extent could these numbers be decreased given that resistant bacteria or so-called superbugs are already here?
What is the role of rapid diagnostics in preventing antimicrobial resistance?
OpGen developed cloud-based software to identify, track, and predict antibiotic-resistant infections. You do this based on genetic information.
Let's elaborate a bit further on how antibiotic resistance occurs. It's clear that bacteria, viruses, fungi, and parasites change over time and no longer respond to medicines. But if a specific patient will respond to a specific drug differs from person to person, right?
What makes a person susceptible to an antibiotic or not?
How does your solution work, in terms understandable to a 5-year-old?
When we talk about superbugs and deaths due to drug-resistant infections, we usually think about hospital-acquired infections. However, the majority of human consumption of antibiotics occurs in the community setting. To which extent is OpGen solution applicable to that?
You are present in 11 EU countries. How exactly do in your opinion, negotiations with healthcare institutions differ based on the country? Are there any specifics you can share?
In order to improve antimicrobial stewardship globally, several things would need to be coordinated: databases about outbreaks and bugs becoming resistant. Broadscale rapid diagnostics would need to be in place to detect the bugs and resistance. Then there's of course the awareness about prescribing, incentives for new antibiotics development etc. What do you see as promising efforts to curb antimicrobial resistance?