Antimicrobial resistance and CRP

Antimicrobial resistance is a global health threat 

Antimicrobial resistance (AMR) means the ability of micro-organisms, including bacteria, viruses, fungi, and parasites, to resist treatment. In most cases, AMR specifically concerns antibiotic resistance, which occurs when bacteria develop the ability to withstand the effects of antibiotics. Antibiotics are the most important drugs to treat bacterial infections. The over- and misuse of antibiotics have driven the development of antibiotic-resistant bacteria, which poses a significant threat to public health. World Health Organization (WHO) has declared AMR as one of the top 10 global health threats¹.

Without preventive actions, AMR will eventually cause more deaths than cancer

Currently, AMR causes 1.3 million direct and almost 5 million indirect deaths per year². If antibiotic resistance continues to evolve, it is estimated that by 2050, 10 million people will die each year from AMR-related infections, which will be more than yearly cancer deaths³. The rise in antibiotic resistance may turn many common treatable infections into life-threatening illnesses. Furthermore, AMR causes a significant economic burden on both the healthcare system and individuals. Patients with resistant infections require longer hospital stays, are more likely to experience severe adverse drug reactions, and may suffer a loss of income due to prolonged illnesses³.

Overuse of antibiotics causes AMR

Approximately 80-90% of all antibiotics used in healthcare are prescribed in primary care⁴, where respiratory infections are the most common reason for the healthcare visit^5,6. Majority of antibiotics are used for the treatment of respiratory infections, although approximately 90% of respiratory infections are caused by viruses or are self-limiting⁶. 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 the overuse of antibiotics. It is estimated that 50% of antibiotics prescribed in primary care are unnecessary or incorrectly prescribed⁷. Even nowadays, antibiotic treatment decisions may be based only on examining patient symptoms without diagnostic confirmation about bacterial infection. Fast quantitative C-reactive protein (CRP) point of care (POC) testing can successfully guide antibiotic prescribing and improve the management of respiratory infections.

Diagnostic uncertainty and misconceptions about antibiotics are the main causes for antibiotic overuse

Several factors, such as cultural conceptions about diseases, and misbeliefs about antibiotics influence on policies how antibiotics are used in different countries. However, the diagnostic uncertainty of the physicians is the main cause for overprescribing of antibiotics all over the world⁸. Differentiation of severe and mild/self-limiting infections may be difficult, and consequently, antibiotics are prescribed just in case to minimize risk for the patients. Patients may also often ask for antibiotics, although they are not needed. Combination of diagnostic uncertainty and patients demands easily leads to overprescribing⁹.

Fast and quantitative CRP POC testing plays a major role in guiding correct and sustainable use of antibiotics

In healthcare, optimization of antibiotic use is a key in fighting against AMR. Antibiotics should be used not only less, but also provided to the patients who benefit from the treatment. Fast and accurate CRP POC testing plays an important role in guiding correct use of antibiotics¹⁰. 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 and immediately available results during the patient visit, increase the diagnostic confidence and aid in treatment decision making whether antibiotics are needed or not
• Decreases unnecessary antibiotic consumption significantly in respiratory tract infections without compromising patient’s health^11-13
• CRP results can be used as a tool when communicating to the patient why antibiotics are not needed. Effective communication will increase also patient satisfaction¹⁴

Testing before prescribing using CRP POC tests supports antimicrobial stewardship and sustainable healthcare practices.

References

1. World Health Organization (WHO). Antimicrobial resistance. Available at https://www.who.int/news-room/fact-sheets/detail/antimicrobial-resistance
2. Antimicrobial Resistance Collaborators. Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis. Lancet 2022; 399:629-655.
3. O’Neill J. Review on Antimicrobial Resistance. Antimicrobial Resistance: Tackling a Crisis for the Health and Wealth of Nations, 2016.
4. Hay AD. Antibiotic prescribing in primary care. BMJ 2019; 364:l780.
5. Petersen I et al. Antibacterial prescribing in primary care. J Antimicrob Chemother 2007; 60 Suppl 1: i43-47.
6. 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.
7. CDC. Antibiotic Use in the United States, 2017: Progress and Opportunities.
8. Harbarth S, Samore MH. Antimicrobial resistance determinants and future control. Emerg Infect Dis 2005; 11:794-801.
9. European Commission. Special Eurobarometer 445: Antimicrobial Resistance. European Commission; Brussels, Belgium: 2016
10. Gentile et al. The role of CRP POC testing in the fight against antibiotic overuse in European primary care: Recommendations from a European Expert Panel. Diagnostics 2023; 13:320.
11. 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.
12. 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.
13. 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.
14. Strumann C et al. Communication training and the prescribing pattern of antibiotic prescription in primary health care. Plos One 2020; 15(5): e0233345