THE ROLE OF DIAGNOSTICS IN THE

ANTIMICROBIAL RESISTANCE RESPONSE

LONDON SCHOOL OF
HYGIENE & TROPICAL MEDICINE

WEEK 1 INTRODUCTION TO THE ROLE OF DIAGNOSTICS IN THE RESPONSE TO

AMR
STEP 1.13 ROLE OF DIAGNOSTICS IN THE AMR RESPONSE - SURVEILLANCE

KAMINI WALIA: All countries today are grappling with the challenge of anti-
microbial resistance. The problem is bigger in low-middle income countries, as
we still don't know, how big is the demon that we are fighting with. Due to the
absence of systematic surveillance systems in low-resource settings, the extent
of anti-microbial resistance in LMICs is largely unknown. Countries with robust
surveillance systems have been able to launch an informed and well-thought-
out response, and have also been successful in curbing this challenge to some
extent. There is no doubt that we understand microbes better today than we
did a few years ago. We now know that microbes are ever changing and ever
evolving.

Added to this is the fact that today, we live in a well-connected world, which
facilitates easier movement of drug-resistant pathogens across countries.
Constant surveillance of drug-resistant pathogens, supported by good quality
diagnostics, is therefore of utmost importance in identifying prevalence of
drug-resistant organisms, and forecasting future outbreaks. For example, from
the data that is being collected on carbapenemase producing organisms, we
know that in the US, we see more of KPCs. In Mediterranean countries, we see
VIMs. And in Asia and South Pacific, we see NDMs and OXAs making up
significant portion of drug resistant infections. These findings enable policy
makers to prepare a response in a timely manner, and plan appropriate control
measures at local, national, and global levels.

Surveillance data is also crucial for planning better treatment strategies with
available arsenal of antibiotics, and inform R and D requirements for future
antibiotics. Good quality data is only possible through quality diagnostics.
Currently, in most LMICs, automated diagnostics to support AMSD are limited
to tertiary care hospitals. Non-availability of quality diagnostics at lower levels
of health care is a major bottleneck in our ability to capture community data.
To address this issue and ensure best possible usage of existing diagnostic
technologies, while preparing the essential diagnostic list, ICMR and WHO
have suggested culture, identification, and anti-microbial susceptibility testings

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to be made available in all district hospitals which are secondary health care
facilities.

If the diagnostics from these facilities are aggregated centrally, it would put us
a big step ahead of bugs and support containment of AMR. Besides, having
good POC diagnostics at different levels of health, as of when these tests are
developed and are available, will also go a long way in strengthening collection
of AMR data at all levels. To measure is to know. And to measure the extent of
AMR, we need surveillance systems for each country, which are supported by
quality diagnostics.

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