Antimicrobial resistance and CRP

Antimicrobial resistance is a global health threat

Antibiotics are the most important drugs to treat bacterial infections. The over- and misuse of antibiotics has driven the development of antibiotic-resistant bacteria. At the same time, many pharmaceutical companies have dropped out the development of new antimicrobial drugs. World Health Organization (WHO) has declared antimicrobial resistance (AMR) as one of the top 10 current global health threats¹. If AMR keeps rising, it is estimated that by 2050, 10 million people will die prematurely every year to AMR related infections. Many common infections that are currently treated with antibiotics may become life-threatening. In addition to increased mortality, AMR causes a huge economic burden for both healthcare system and individual people. Patients require longer hospitalization, may have more serious adverse events from drugs related to the treatment of antimicrobial resistant pathogens, and have a loss of income due to their prolonged illnesses².

Incorrect antibiotic use causes AMR

Approximately 80-90% of all antibiotics used in healthcare are prescribed in primary care³, where respiratory infections are the most common reason for the healthcare visit^4,5. Majority of antibiotics are used for the treatment of respiratory infections, although approximately 90% of respiratory infections are caused by viruses or are self-limiting⁵. Treatment of viral and self-limiting infections with antibiotics does not provide any clinical benefit for the patients but promotes antibiotic resistance.

The main factor that has driven the development of AMR is incorrect antibiotic use. It is estimated that 50% of prescribed antibiotics are unnecessary or incorrectly prescribed⁶. Even nowadays, it is common that antibiotics are prescribed without diagnostic confirmation about bacterial infection only examining patient symptoms. Wide spectrum antibiotics are often used as the first line choice although they should be used only when necessary. Rapid point of care C-reactive protein (CRP) testing can successfully guide antibiotic prescribing and improve the management of respiratory infections.

Diagnostic uncertainty and misconceptions about antibiotics are key factors that drive the overuse of antibiotics

Several factors, such as cultural conceptions about diseases, socio-economic factors, and misbeliefs about antibiotics influence on policies how antibiotics are prescribed in different countries. However, the diagnostic uncertainty of the practitioners is the main cause for overprescribing of antibiotic⁷. It is often difficult to differentiate viral and bacterial infections and self-limiting infections from the ones requiring treatment. To minimize risk for the patients, antibiotics are given just in case. When diagnostic uncertainty is combined with the patient’s demand for antibiotics due to common misbeliefs about antibiotics, such as that antibiotics can cure viral infections, antibiotic prescribing becomes easily irrational⁸.

Fast quantitative CRP point of care testing reduces unnecessary antibiotic prescribing in primary care

In healthcare, proper use of antibiotics is key in fighting against AMR. Proper use is not only reducing prescribing but also providing antibiotics to the patients who benefit from the treatment. Fast and accurate diagnostics play an important role in decreasing antibiotic overuse^2,9. C-reactive protein (CRP) point of care (POC) testing before prescribing has several advantages that aid in tackling AMR:

• Tests are accurate, affordable, and easy-to-use with a small sample volume
• Fast results are immediately available during the patient visit, decrease the diagnostic uncertainty and aid in treatment decision making whether antibiotics are needed or not
• Decrease significantly unnecessary antibiotic consumption in respiratory tract infections without compromising patient’s health^10-12
• CRP results can be used as a tool when communicating to the patient why antibiotics are not needed. Effective communication will increase also patient satisfaction¹³

References

1. World Health Organization (WHO). Antimicrobial resistance. Available at https://www.who.int/news-room/...
2. O’Neill J. Review on Antimicrobial Resistance. Antimicrobial Resistance: Tackling a Crisis for the Health and Wealth of Nations, 2016.
3. Hay AD. Antibiotic prescribing in primary care. BMJ 2019; 364:l780.
4. Petersen I et al. Antibacterial prescribing in primary care. J Antimicrob Chemother 2007; 60 Suppl 1: i43-47.
5. Bjerrum L et al. Health Alliance for Prudent Prescribing, Yield and Use of Antimicrobial Drugs in the Treatment of Respiratory Tract Infections (HAPPY AUDIT). BMC Fam Pract 2010; 11:29.
6. CDC. Antibiotic Use in the United States, 2017: Progress and Opportunities.
7. Harbarth S, Samore MH. Antimicrobial resistance determinants and future control. Emerg Infect Dis 2005; 11:794-801.
8. European Commission. Special Eurobarometer 445: Antimicrobial Resistance. European Commission; Brussels, Belgium: 2016
9. WHO. Antimicrobial resistance and primary health care. Technical series on primary health care, 2018. https://apps.who.int/iris/hand...
10. Aabenhus R et al. Biomarkers as point-of-care tests to guide antibiotics in patients with acute respiratory infections in primary care. Cochrane Database of Systematic Reviews 2014; 11:CD010130.
11. Tonkin-Crane SKG et al. Clinician-targeted interventions to influence antibiotic prescribing behaviour for acute respiratory infections in primary care: an overview of systematic reviews (Review). Cochrane Database of Systematic Reviews 2017; 7(9):CD012252.
12. O'Brien K et al. C-reactive protein point-of-care testing (CRP POCT) to guide antibiotic prescribing in primary care settings for acute respiratory tract infections (RTIs). Rapid assessment on other health technologies using the HTA Core Model for Rapid Relative Effectiveness Assessment. EUnetHTA Project ID: OTCA012, 2019.
13. Strumann C et al. Communication training and the prescribing pattern of antibiotic prescription in primary health care. Plos One 2020; 15(5): e0233345.