Rapid, diagnostic test from India may help stem super bug crisis

This week a prize was announced that is likely to have far-reaching implications in the world of health care. Despite its importance most of the community is unaware of the event. The winner of the Longitude prize is poised to spearhead a revolution in the field of infection management and global efforts to tackle antimicrobial resistance. The £8million ( ₹85 crore) Longitude Prize on Antimicrobial resistance (AMR), first announced in 2014, revealed its winner at an event in London’s Science Museum. The PA-100 AST System from Sysmex Astrego is a high-tech, transformative, rapid, point-of-care test for UTIs (Urinary Tract Infection).

Rational use of antibiotics — choosing the appropriate antibiotic for the correct patient at the optimal time — is fundamental in saving lives and combating the superbug crisis. Rapid diagnostics are poised to be crucial in this effort. The winner of the Longitude Prize is set to spearhead the list of emerging rapid diagnostic technologies in a transformative manner. The applications for the Longitude Prize bring hope, suggesting that through collective action, we can look forward to a future protected from the threats of antimicrobial resistance.

The crisis is imminent: Antibiotic-resistant infections killed nearly 1.3 million people globally in 2019 and are on course to cause 10 million deaths a year by 2050, outstripping deaths caused by cancer. The global economy may lose up to 4 trillions by 2030 and up to 100 trillions by 2050 due to the AMR crisis.

What does the prize mean?

Most advanced tests in medical practice today are PCR-based, but the PA-100 AST System from Sysmex Astrego has developed a transformative technology based on a phenotypic test. This test identifies the bacteria causing the urinary tract infection and performs antibiotic susceptibility testing (AST) to determine the effective antibiotic for the specific patient in under 45 minutes.

The test uses a single-use cartridge, the size of a smart phone. Less than half a millilitre of the urine is added to this cartridge. Bacteria in the urine is trapped in over 10,000 microfluidic traps in parallel arrays and exposed to five different antibiotics at five different concentrations. The cartridge is inserted into a reader instrument, the size of a shoe box, where bacterial growth is monitored by phase-contrast imaging. The reader provides a report , “sensitive” or “resistant” for each antibiotic in 30-45 minutes. This supports doctors and health workers in their clinical decision making at the point of care, and opens up the significant possibility of previously “retired” first-line antibiotics coming back into use for the majority of patients.. Accurate, rapid diagnosis of bacterial infections that help doctors and health workers manage and target antibiotics, will slow the development and spread of antibiotic resistant infections, improve healthcare and save potentially millions of lives.

The test represents a huge advance over the current turnaround time of 2-3 days. The test will help doctors prescribe the right antibiotic at the right time, rather than waiting for 3 days and resorting to empirical antibiotic prescription. The test can be performed in a doctors clinic rather than sending the urine sample to a laboratory. When a patient with symptoms of urinary infection visits a doctor, if the new technology is used , the doctor will know within 45 minutes ,whether the patient has urinary infection or not and if there is an infection which antibiotic will work. The test is transformative, accurate, and affordable for patients worldwide.

Currently there are two types of tests available to diagnose urinary infection.

The first one is the urine dipstick test that can be done as a point-of-care test. Point-of-care diagnostic tests are tests that can be performed in the clinic, emergency departments, hospital wards, or pharmacy counters, without the need to send the sample to a laboratory. The advantage of the dipstick is that results are available in a couple of minutes, which helps doctors decide whether to start antibiotics or not. Unfortunately accuracy is not more than 50-60%. Even if the doctor carries out a dipstick despite its limitations, the test doesn’t help the doctor choose the right antibiotic.

For this, the urine sample must be sent to the laboratory for culture. The culture results take a minimum of 2-3 days. But the doctor cannot wait 2-3 days to start an antibiotic. So, even if the doctor sends a urine sample for culture, they still have to start an antibiotic empirically, based on educated guesswork, before the culture results are ready. By this time, the patient has already completed a full or half course of antibiotics. Such blind antibiotic prescriptions are a major cause of the antibiotic resistance crisis, especially in countries like India. A transformative, rapid point of care diagnostic test that is accurate and affordable has the potential to revolutionise urinary tract infection treatment in India and worldwide. Current urinary tract infection management in most cases is based on a 50:50 rationale. Only 50% of patients with symptoms of urinary infection have an actual infection, and the accuracy of a urine dipstick is 50-60%.

In India, every year, millions of patients with urinary tract infections visit doctors or pharmacies seeking treatment. These infections result in significant loss of lives, burden the healthcare system, and have a socio-economic impact. In 20-30% of sepsis patients, the infection originates from the urinary tract. Up to two in five people who develop severe sepsis will lose their lives. Hence, rapid and accurate point-of-care tests for urinary tract infection can save millions of lives worldwide, especially in India. The solution is a rapid, accurate, and affordable test that can help the doctor diagnose urinary infection accurately and provide information on the correct antibiotic that can cure the infection.

What is the Longitude Prize?

In 1714, the British government announced the Longitude Prize to solve the longitude problem, literally. In the 18th century, thousands of ships were lost at sea because sailors couldn’t determine the position of the ship at sea. If a ship doesn’t know where it is, it risks being shipwrecked.

To determine the position of a ship, both latitude and longitude are needed. Latitude was easy to measure by observing the sun, moon, and stars, but longitude was a mystery. The British government announced the Longitude Prize for an invention that helps calculate longitude. John Harrison, a watchmaker, invented an ingenious device that could calculate longitude perfectly and won the prize.

300 years after the first Longitude Prize, the Britain launched a second Longitude Prize. The public was asked to vote for a major challenge that needed an immediate solution, such as global warming, food shortage, and water shortage. The public voted for Anti Microbial Resistance. A ten million pound Longitude Prize was announced in 2014. Of this, £ 2 million was awarded to various innovators to refine their technology. The final winner receives £ 8 million.

The Longitude Prize on AMR intends to incentivise the creation of new diagnostic tests that, in a matter of minutes, can identify whether an infection is bacterial, and if so, the right antibiotic to prescribe to slow the spread of antibiotic resistant infections. The goal is to replace the 2–3-day lab test process that doctors and patients must currently endure, and end “just in case” prescribing that is prevalent as a result, which promotes the development of antibiotic resistance.