Laboratory medicine: confronting infections with speed and foresight
Laboratory medicine: confronting infections with speed and foresight
The laboratory is one of the most important and pivotal bastions in patient care. In the laboratory, acute, chronic and genetic diseases are diagnosed, the progression of diseases such as diabetes is regularly checked or specialists look for biomarkers to adapt cancer therapies.
These tasks are primarily performed by outpatient labs given that thousands of samples are sent daily from medical offices to central laboratories or considering that large medical practices or medical centers operate their own laboratory facilities. As of 2009, Germany registered approximately 350 laboratories for outpatient care, compared to about 1,400 laboratories in hospital facilities. German statutory health insurance spent 2.2 billion Euros for outpatient and 3.2 billion Euros for inpatient laboratory testing services in 2013. Two-thirds of medical diagnoses and decisions in Germany are based on lab results (all data provided by the German Association of Clinical Laboratory Physicians (Berufsverband Deutscher Laborärzte e.V.)).
This is why the laboratory is a key component of patient care – pertaining to both outpatient and inpatient care. Compared to the outpatient sector, the laboratory and laboratory medicine play an even bigger role in hospitals. Their services are particularly needed when patients in hospitals are threatened by severe infections. This applies especially to those patients whose immune system is weakened and who are no longer able to fight infections on their own. This is when physicians have to start treatment as quickly as possible but are faced with two obstacles. First, the exact type of pathogen needs to be identified to be able to subsequently choose the right type of medicine. In addition, potential antimicrobial resistance needs to be determined for the treatment to be effective.
Reduced diagnosis time means more time for treatment
Bacteria that are resistant to multiple antibiotics pose a growing threat. These multi-drug resistant bacteria, abbreviated MDR bacteria, can spread from patient to patient in hospitals, while there are hardly any remedies left to fight them. It takes a lot of time to determine the right type of antibiotic. Until then, physicians have to rely on their own judgment, which sometimes does not yield the desired results.
Ideally, prevention in the form of early and comprehensive diagnostic evaluation can prevent an infectious disease outbreak. In the Netherlands, which frequently serves as a role model when it comes to the prevention/control of MDR bacteria, patients are screened extensively. "We identify a carrier and are thus able to prevent the transmission of multidrug-resistant bacteria. This also enables us to detect patients, who – if they become infected – immediately receive the right antibiotic treatment," explains Prof. Alexander W. Friedrich, Projekt Director of EurSafety Health-Net, in an interview with MEDICA-tradefair.com. EurSafety Health-Net aims to improve patient safety as it relates to MDR infections in the cross-border region between Germany, the Netherlands and Belgium.
If all preventive measures by the hospital fail, laboratory automation systems save time in diagnostic testing. They can autonomously cultivate and read samples. While automation already supports the many daily routine procedures in laboratories today, there is no end in sight when it comes to developments.
Since 2015, we also know that different types of bacteria can swap resistance genes instead of developing mutations on their own – as is the case with the mcr-1 gene, which can make bacteria resistant to Colistin, a "last-resort antibiotic". Recently, an easy-to-use rapid test, which in the future might be directly applied to the sample material rather than the microbial culture, was successfully evaluated by the German Center for Infection Research (DZIF) and the University of Giessen. Aids like this test are able to assist laboratories in identifying resistances in the future.
This does not signal the end of potential development in this area. Could it be possible to predict resistances early on in the future instead of detecting them retroactively? Bioinformatics researchers at the Saarland University want to make this possible by comparing genetic abnormalities in bacterial strains with their response to antibiotics. The foundation for their research is provided by the GEAR ("Genetic Antibiotic Resistance and Susceptibility") database, which contains information of bacterial strains from patient samples of the past 30 years. The analysis is meant to support the development of future rapid tests but also intends to reduce the time it takes to diagnose infections by correlating genetics and responses to antibiotics.
Sepsis: when a diagnosis becomes a race against time
Rapid diagnosis and the derived treatment decision are especially important when an infection spreads within the body and leads to sepsis. A new approach to the diagnosis of sepsis developed by the University Medical Center Mannheim uses big data for the early detection of sepsis or "systematic inflammatory response syndrome" (SIRS). Although this type of early detection does not fall under the laboratory medicine umbrella since it requires a continuous collection and monitoring of data from the intensive care patient, the early warning could give attending physicians more time for treatment and further diagnostic testing.
Despite these types of progress, traditional methods such as cultivation and rapid testing need to be further developed. One foundation for this has been created in the ImSpec project for example: "Mycoses are hard to diagnose, because cultivating funguses takes even longer than cultivating bacteria – we are talking several days," explains Dr. Wolfgang Fritzsche from the Leibniz Institute of Photonic Technology in an interview with MEDICA-tradefair.com. "With our project, we wanted to show that the simultaneous, parallel detection of different pathogens is possible. We demonstrated this with the example of sepsis," Fritzsche continues.
Laboratory medicine: building block of infection prevention
Thanks to laboratory medicine, physicians today are able to successfully face up to many diseases. Having said that, when it comes to infectious diseases, it is no longer enough to clearly identify the enemy. The speed of diagnosis is also becoming increasingly important because, without the early detection of pathogens, physicians are only able to react. A faster diagnosis that lets them take back the initiative and good prevention of infections and the spread of resistance at hospitals are crucial, as the example of the Netherlands shows. Although laboratory medicine and its future advances play an important role in all this, they are, however, not the only leading actors. They also always work hand in hand with sanitation and hygiene management and employees, who consistently implement the hygiene measures.