Antibiotic resistance happens when microorganisms develop the ability to defeat the drugs designed to kill them. Resistance appeared as soon as antibiotics were used in clinics, but what is different in recent years, is the accumulation of different resistance mechanisms together in the same bacteria, rendering the microorganism identifiable as MDR/PDR/XDR depending from the number of antibiotic classes involved in the resistance. Despite any classification, these microorganisms are responsible for difficult-to-treat (DTT) infections, requiring extended hospital stays, additional follow-up doctor visits, and costly and toxic alternatives.
Italy, as some other countries in the Mediterranean area, is in the “eye of the cyclon” for MDR rates in species included on the WHO black-list.
The need to have a national plan to prevent and control the diffusion of MDR organisms and to slow the emergence of resistant bacteria was realized by our Minister of Health, organizing a task force with the objective to homogenize a common behavior throughout the country. In November 2017, the document, in agreement between the government, the regions and the autonomous provinces, was published.
In the light of the one-health vision and among the different objectives, the plan strengthens the role of the clinical microbiological laboratory, including surveillance efforts, advances in the development and use of rapid and innovative diagnostic tests for the identification and characterization of resistant bacteria (also in the implementation of antimicrobial stewardship programs in every hospital setting), to accelerate the optimal and appropriate use of old and, above all, of the new – limited in number – antibiotics.
In this context, the inclusion of indication of Rapid diagnostic testing and rapid antimicrobial susceptibility testing (often on multiple platforms) was especially indicated as important for many cases such as severe infections, for which a delay in initiating effective therapy is a strong predictor of death.
Clinical microbiology seems to be really at a crossroad: on the one hand the pressure to cut costs (above all related to laboratory costs), and on the another, i) the crisis of antimicrobials, ii) the increase of DTT organisms resulting in the need to optimize therapies, and iii) the proliferation of innovative, rapid diagnostic tools, boost the clinical relevance of clinical microbiologists, never seen before. The equilibrium of all these different forces resides in the use of algorithms, but also integrations and clinical decision support systems to develop actionable alerts to implement the stewardship programs towards an even more personalized medicine.