Latest innovations in AMR diagnosis and mitigation

World Antimicrobial Resistance Awareness Week: Addressing a pressing global issue

World Antimicrobial Resistance Awareness Week (WAAW) plays a vital role in highlighting the increasing issue of antimicrobial resistance and its detrimental impact on human and animal health (Ashwati Sarman, The Risks of AMR, 2023).

Already recognized by the World Health Organization (WHO) as one of the top 10 global health threats, it has now been confirmed as a universal risk that jeopardizes health and affects food production and the environment.

These drug-resistant pathogens pose a threat to everyone, everywhere.

Global action plans and national visions for AMR management

AMR mitigation efforts date back to 2015 when the World Health Assembly adopted a five-point Global Action Plan (GAP) to increase investment in new medications, vaccines, and diagnostic tools (WHO, 2015).

The UK launched its 20-year AMR vision in 2019, emphasizing a future where AMR is effectively managed. Diagnostics are pivotal in AMR control, playing a critical role in patient care, antimicrobial stewardship, and routine surveillance (Global and Public Health Group, Emergency Preparedness and Health Protection Policy, 2019).

In all plans to manage and mitigate AMR, diagnostics play a crucial role.

The WHO’s strategic approach to AMR: Prioritizing diagnostics

In May 2023, the WHO adopted Resolution WHA76.5 to strengthen AMR diagnostic capacity. This resolution emphasizes local production of diagnostic resources, regulatory optimization, and improved accessibility to support quality diagnostics worldwide.

Through its AMR Diagnostic Initiative, the organization seeks to elevate diagnostics in AMR response, ensuring equitable, safe, and affordable access across healthcare systems. This was adopted by member states during the Seventy-Sixth World Health Assembly.

Key objectives of the AMR Diagnostic Initiative include:

• Bringing diagnostics to the forefront of the global response to AMR, to support patient management, antimicrobial stewardship, infection prevention, control interventions and enhance routine surveillance.
• Enabling equitable access to quality testing for common pathogens in all healthcare settings.

The building blocks of success

To achieve these goals, the Antimicrobial Resistance Diagnostic Initiative encompasses four building blocks (Global and Public Health Group, Emergency Preparedness and Health Protection Policy Directorate, 2024):

• Strategic and operational guidelines to help member states enhance laboratory services, through setting strategic goals, objectives, implementation considerations, and technical guidance.
• Standardized tools for tracking AMR at national and global levels via laboratory services.
• A global AMR laboratory network, consisting of designated WHO labs at various levels.
• Innovation in diagnostics to support new solutions for AMR.

Effective diagnostics are essential in the fight against AMR, as they enable the early detection of resistant pathogens, guide appropriate antimicrobial use, and help monitor AMR spread (Georgia D. Kaprou, 2021). Rapid pathogen detection is critical for effective infectious disease treatment, yet many current diagnostic processes still require several days to deliver results.

This delay often forces clinicians to begin broad-spectrum antimicrobial treatments without a confirmed diagnosis, which can compromise patient health and exacerbate AMR.

To address this, there is an urgent need for rapid, sensitive, and cost-effective diagnostic platforms that accelerate antimicrobial susceptibility testing. These tools empower healthcare providers to deliver more targeted therapies and reduce the use of unnecessary antimicrobials.

Rapid diagnostic tests (RDTs) are particularly impactful, as they not only reduce mortality rates but also shorten hospital stays and lower healthcare costs by supporting more precise and efficient treatment decisions.

Innovations in diagnostics: From traditional tests to CRISPR-based solutions

The landscape of AMR diagnostics has evolved significantly, moving from conventional tests to advanced CRISPR-based diagnostics, which offer faster and more precise detection capabilities (Sahar Serajian, 2021).

Table 1: Evolution of AMR Diagnostic testing

Building diagnostic capacity worldwide

With around 70 per cent of healthcare decisions reliant on diagnostics, only 3 to 5 per cent of budgets are allocated to these services (WHO, 2022), with many countries lacking essential diagnostic tools.

The WHO Diagnostics Task Force addresses this gap, collaborating across WHO programs to support diagnostic implementation, especially in low-resource areas.

The task force assists countries in evaluating diagnostic needs, ensuring quality, and providing training to healthcare professionals on effective diagnostic use.

It also offers advice on the selection and prioritization of essential diagnostics to help strengthen health systems.

Additionally, it provides training to healthcare workers on how to use diagnostics effectively, from primary care to complex procedures requiring specialized skills.

Applying COVID-19 lessons to AMR

The COVID-19 pandemic offered valuable insights into AMR response.

In 2021, the UK Academy of Medical Sciences’ Forum, the Department of Health and Social Care (DHSC), and the National Institute for Health and Care Research (NIHR) came together to identify the key lessons from the pandemic response and their potential application to dealing with AMR (The Academy of Medical Sciences, 2022).

Notable themes included:

• Leveraging the COVID-19 testing infrastructure
• Engagement with the industry
• Fostering multi-stakeholder collaboration
• Promoting technical innovations and public adoption
• Improving regulatory pathways

Global AMR surveillance: Challenges and opportunities

The WHO’s Global Antimicrobial Resistance Surveillance System (GLASS) enables data collection and analysis of AMR trends and plays a crucial role in informing global and local responses.

Despite its importance, challenges persist, especially in low-resource settings where costs and infrastructure pose barriers.

Ensuring quality and standardized diagnostic protocols and regulatory frameworks across regions remains essential, as does training for healthcare providers on how to integrate diagnostics and interpret results into clinical practice effectively.

AI and the future of AMR diagnostics

Artificial intelligence (AI) has huge potential to enhance diagnostic accuracy by analyzing complex datasets and identifying AMR patterns.

Continued innovation in developing affordable, rapid, and user-friendly diagnostics is key to fighting AMR, helping to identify infections swiftly and accurately, reduce antimicrobial misuse, and enable targeted therapies.

References

Ashwati Sarman, 2023. gandlhealth.com. (Online). Available at: https://www.gandlhealth.com/knowledge-hub/amr-week-day-two-the-risks-of-amr (Accessed 11 November 2024).

Georgia D. Kaprou, I. B. E. A. A. A. A.-O. M. P., 2021. Rapid Methods for Antimicrobial Resistance Diagnostics. MDPI - Antibiotics, 10(2), p. 209.

Global and Public Health Group, Emergency Preparedness and Health Protection Policy Directorate, 2024. CONFRONTING ANTIMICROBIAL RESISTANCE 2024 TO 2029, London: HM GOVERNMENT.

Global and Public Health Group, Emergency Preparedness and Health Protection Policy, 2019. Contained and controlled-The UK’s 20-year vision for antimicrobial resistance, London: HM GOVT.

Sahar Serajian, E. A. S. M. R. O. M. d. L. P. S. H., 2021. CRISPR-Cas Technology: Emerging Applications in Clinical Microbiology and Infectious Diseases. Pharmaceuticals (Basel), 14(11), p. 1171.

THE ACADEMY OF MEDICAL SCIENCES, 2022. Antimicrobial resistance research: learning lessons from the COVID-19 pandemic, London: NIHR - DEPARTMENT OF HEALTH AND SOCIAL CARE.

WHO, 2015. Global Action Plan on Antimicrobial Resistance, Geneva: WHO Library Cataloguing-in-Publication Data.

WHO, 2022. World Health Organization - Strengthening diagnostics capacity. (Online). Available at: https://www.who.int/activities/strengthening-diagnostics-capacity (Accessed 10 November 2024).

WHO, 2023. Antimicrobial Resistance Diagnostic Initiative: strengthening bacteriology and mycology, Geneva: WHO AMR Division.

WHO, 2023. Antimicrobial Resistance Diagnostic Initiative: strengthening bacteriology and mycology, Geneva: WHO AMR Division.

WHO, 2023. STRENGTHENING DIAGNOSTICS CAPACITY 152nd Session Sixth Meeting. Geneva, WHO.

WHO, 2023. WHO Strategic and Technical Advisory Group for Antimicrobial Resistance (STAG-AMR): report of the third meeting, 13-15 June 2023, Geneva: World Health Organization.

Ashwati Sarman is a Regulatory Executive at G&L.