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  • VALUE-Dx annual meeting recap

    VALUE-Dx annual meeting recap

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    [av_heading heading=’VALUE-Dx annual meeting recap’ tag=’h3′ style=’blockquote modern-quote modern-centered’ subheading_active=’subheading_below’ show_icon=” icon=’ue800′ font=’entypo-fontello’ size=” av-desktop-font-size-title=” av-medium-font-size-title=” av-small-font-size-title=” av-mini-font-size-title=” subheading_size=’15’ av-desktop-font-size=” av-medium-font-size=” av-small-font-size=” av-mini-font-size=” icon_size=” av-desktop-font-size-1=” av-medium-font-size-1=” av-small-font-size-1=” av-mini-font-size-1=” color=” custom_font=” subheading_color=” seperator_color=” icon_color=” margin=” margin_sync=’true’ av-desktop-margin=” av-desktop-margin_sync=’true’ av-medium-margin=” av-medium-margin_sync=’true’ av-small-margin=” av-small-margin_sync=’true’ av-mini-margin=” av-mini-margin_sync=’true’ headline_padding=” headline_padding_sync=’true’ av-desktop-headline_padding=” av-desktop-headline_padding_sync=’true’ av-medium-headline_padding=” av-medium-headline_padding_sync=’true’ av-small-headline_padding=” av-small-headline_padding_sync=’true’ av-mini-headline_padding=” av-mini-headline_padding_sync=’true’ padding=’10’ av-desktop-padding=” av-medium-padding=” av-small-padding=” av-mini-padding=” icon_padding=’10’ av-desktop-icon_padding=” av-medium-icon_padding=” av-small-icon_padding=” av-mini-icon_padding=” link=’manually,http://’ link_target=” title_attr=” id=” custom_class=” template_class=” av_uid=’av-kx4q0z2f’ sc_version=’1.0′ admin_preview_bg=”][/av_heading]

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    In September, the annual VALUE-Dx General Assembly took place in Barcelona. It was a fruitful meeting during which each work package gave an update on their work. High on the agenda were the sustainability of the project, health economic modelling and target product profiles. Insightful updates on the PRUDENCE and ADEQUATE clinical trials were also given, discussing cost effectiveness and process evaluation. It was a successful event filled with interesting exchanges and brainstorming about how to further improve collaborations. 

    Next year in September, the VALUE-Dx Closing Conference will be held, marking the end of the project. During this event, the focus will mainly lie on the sustainability report, centered around the sustainability of the knowledge and valuable materials gained from the project. 

    The meeting presentations and recordings will soon be available on the VALUE-Dx virtual learning platform. 


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  • Stakeholders’ views and experiences on implementing new diagnostics in primary care

    Stakeholders’ views and experiences on implementing new diagnostics in primary care

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    A qualitative study from the VALUE-Dx Social Science Team has recently been published in Frontiers in Public Health. It is part of their World Antibiotic Awareness Week research topic. 

    The team researched the views and experiences of stakeholders on implementing new diagnostics in primary care to support managing community-acquired acute respiratory tract infections. Twenty-six stakeholders participated, from Belgium, the United Kingdom and several EU-level organisations. 

    The study gives insights into areas of the unmet need in diagnostic implementation and provides recommendations for research and practice based on the stakeholder interviews. Stakeholders stressed the need to engage with clinicians to act as champions for tests to help raise awareness and generate new evidence on how tests are used. While acknowledging the potential of point-of-care tests for improving patient outcomes and impacting antibiotic prescribing behaviour, some raised concerns on how tests would be used in practice and wished to see national data on effectiveness. 

    Read more here. 
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  • AMR expert interview with Dr. Agnes Sonnevend

    AMR expert interview with Dr. Agnes Sonnevend

    AMR expert interview with Dr. Agnes Sonnevend

    Read our interview with Dr. Agnes Sonnevend from the Pécs University Hospital in Hungary. Dr. Sonnevend elaborates on the importance and challenges of tackling AMR, her role in this and more.

    Can you introduce yourself and tell us about your role in the AMR field?

    I am Agnes Sonnevend, head of the Diagnostic Microbiology Services at University of Pécs University Hospital in Hungary, which has over 1400 beds. We treat patients in the fields of haematology, oncology, solid organ transplantation, both children and adults. Previously, I did research in the Middle East on antimicrobial resistant bacteria, mostly gram-negatives, and molecular epidemiology. I’m continuing this work in Hungary with the help of my PhD-students and colleagues. I am also part of the National Antimicrobial Resistance Testing Committee, which aims to improve the overall quality of antimicrobial susceptibility testing in Hungary and adhere to the EUCAST.  

    What are some challenges that you are currently facing?

    In the committee, we are currently discussing selective reporting and whether or not to suppress certain antibiotics to decrease their use in outpatient settings. There is also a debate ongoing about accidentally discovered multidrug-resistant organism carriers. In my opinion, this is a pressing issue and we need to figure out how to approach it. 

    Why should people be concerned about AMR?

    The most important aspect of AMR is that it’s not only a current problem, but it will also gravely affect generations to come. In Europe, antibiotics are not over-the-counter available, however, in most other parts of the world this unfortunately is the case. This means that a lot of people take antibiotics even if they have a simple cold or hay fever. Doctors also need to be selective when it comes to prescribing antibiotics and think about future patients who will potentially need antibiotics for more serious infections. If the widespread over-use of antibiotics continues, then our children and the future generations will not be able to take effective antibiotics. Even simple infections could become life-threatening.

    What is the expected impact of the work you’re doing?

    At the Diagnostic Microbiology Services of the University Hospital, we perform molecular testing for multi-resistant organisms, often genome-sequence based. In this case, it’s easier to pinpoint connections and determine the necessary actions to be taken. Thanks to this, our hospital is able to handle antimicrobial resistance well. I advocate for providing funding to all hospitals so that they can perform this testing as well. Our National Center of Epidemiology carries out these tests, but the turnover time is long. When hospitals can do these tests immediately themselves, actions can be taken faster in order to control hospital infections.

    One of the aims of VALUE-Dx is to demonstrate the value of diagnostics to change the antibiotics prescribing behaviour. Can you comment on this?

    During the COVID-19 pandemic, we used syndrome-based molecular tests to quickly diagnose intensive care patients and determine whether COVID is the cause of their deteriorating lung function or a superinfection, for example. The use of diagnostics definitely contributed to controlling antibiotic prescribing during this time. Running molecular tests can be very helpful for ICU physicians who oftentimes have to make quick decisions.

    In regards to AMR, what’s the current situation in your country?

    In Hungary, there are a lot of cases of multidrug-resistant bacteria called Acinetobacter. Luckily in Pécs, the situation is under control, on average we only have about 10 to 12 cases per year. Due to the Ukrainian refugees, there is also a rising problem of carbapenem-resistant Klebsiella in the East of the country which is slowly spreading to the centre of Hungary. These are not the only resistance issues we face, so there is a strong need to further take serious infection control measures, and other actions, i.e. broadening the use of antimicrobial stewardship.

    Are there any antibiotic resistance awareness campaigns towards the general public?

    Only during the World Antibiotic Awareness Week in November each year, but besides that no. There is still a lot of work to be done when it comes to educating the general public. However, another important factor is convincing insurance companies and national bodies to provide financing for diagnostic testing. In most cases, these tests cost more than running the actual antibiotic course. Governments should promote the use of point-of-care tests, which are available and quick, and benefit the antibiotic prescribing rates. If diagnostics can be done more accurately, this will also have a positive effect on the stay of patients in the ICU. Hospital management should become more aware of this.  

    • About Agnes Sonnevend

    Agnes Sonnevend MD, PhD is an associate professor and consultant clinical microbiologist at the Department of Medical Microbiology and Immunology, Pecs University Medical School. She is the Head of Laboratory of Diagnostic Microbiology and Hospital Hygiene. Dr. Sonnevend’s main research areas are the molecular epidemiology of various multi-drug resistant organisms, the emergence and spread of such organisms, with special focus on plasmid and transposon mediated horizontal gene transfer of resistant determinants in Gram-negative bacteria, e.g. Enterobacterales, Acinetobacter baumannii and other non-fermenters isolated from clinical samples as well as from the environment and livestock.

    More interviews

  • VALUE-Dx real-time inclusions

    VALUE-Dx real-time inclusions

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    [av_heading heading=’VALUE-Dx real-time inclusions’ tag=’h3′ style=’blockquote modern-quote modern-centered’ subheading_active=’subheading_below’ show_icon=” icon=’ue800′ font=’entypo-fontello’ size=” av-desktop-font-size-title=” av-medium-font-size-title=” av-small-font-size-title=” av-mini-font-size-title=” subheading_size=’15’ av-desktop-font-size=” av-medium-font-size=” av-small-font-size=” av-mini-font-size=” icon_size=” av-desktop-font-size-1=” av-medium-font-size-1=” av-small-font-size-1=” av-mini-font-size-1=” color=” custom_font=” subheading_color=” seperator_color=” icon_color=” margin=” margin_sync=’true’ av-desktop-margin=” av-desktop-margin_sync=’true’ av-medium-margin=” av-medium-margin_sync=’true’ av-small-margin=” av-small-margin_sync=’true’ av-mini-margin=” av-mini-margin_sync=’true’ headline_padding=” headline_padding_sync=’true’ av-desktop-headline_padding=” av-desktop-headline_padding_sync=’true’ av-medium-headline_padding=” av-medium-headline_padding_sync=’true’ av-small-headline_padding=” av-small-headline_padding_sync=’true’ av-mini-headline_padding=” av-mini-headline_padding_sync=’true’ padding=’10’ av-desktop-padding=” av-medium-padding=” av-small-padding=” av-mini-padding=” icon_padding=’10’ av-desktop-icon_padding=” av-medium-icon_padding=” av-small-icon_padding=” av-mini-icon_padding=” link=’manually,http://’ link_target=” id=” custom_class=” template_class=” av_uid=’av-kx4q0z2f’ sc_version=’1.0′ admin_preview_bg=”][/av_heading]

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    Recently, two real-time graphs were added to the VALUE-Dx website, as an easy tool to track the inclusion progress of the PRUDENCE and ADEQUATE trails. This information is crucial because at the start of these trials, a target number of patients was set that has to be included for the trials to have statistical “power”. If these targets aren’t met, there is a risk that the studies will be considered unsuccessful because the research questions couldn’t be answered with enough certainty. 

    The graphs are updated on a daily basis and show how many patients are recruited per site or per country. Thanks to this data, it becomes clear which sites or countries are recruiting well and which are lagging behind the inclusion schedule. These sites or countries are then approached to see how they can be supported in order to reach the target. 

    PRUDENCE (Primary Care)

    The PRUDENCE graph indicates the number of patients per setting and country. It is split up into patients in primary care and in long-term facility care. Within this trial, a country can have several sites, for example multiple GP offices in Primary Care. 

    ADEQUATE (Emergency Rooms)

    The ADEQUATE graph is also split up into two parts, the left part shows the number of paediatric patients enrolled per site and the right one the total number. 

    The inclusion graphs have been created by the VALUE-Dx Data Management & Analytics team at the UMC Utrecht. The inclusion graphs are just one example of the team’s output. Other graphs are crucial tools to monitor data quality and the data cleaning process. 

    About the trials

    The PRUDENCE trial researches whether having a community-acquired acute respiratory tract infections diagnostic (CA-ARTI-Dx) test result available when a clinician is considering, or plans to prescribe an antimicrobial, leads to more appropriate prescribing decisions, without causing harm to patients.

    The ADEQUATE trial is a randomised controlled trial of rapid syndromic diagnostic testing for enhancing the quality of antibiotic prescribing for community acquired acute respiratory tract infection (CA-ARTI) in emergency rooms in Europe.
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  • VALUE-Dx paper BJGP Number 1 Most Read Article

    VALUE-Dx paper BJGP Number 1 Most Read Article

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    [av_heading heading=’VALUE-Dx paper in BJGP Top 10′ tag=’h3′ style=’blockquote modern-quote modern-centered’ subheading_active=’subheading_below’ show_icon=” icon=’ue800′ font=’entypo-fontello’ size=” av-desktop-font-size-title=” av-medium-font-size-title=” av-small-font-size-title=” av-mini-font-size-title=” subheading_size=’15’ av-desktop-font-size=” av-medium-font-size=” av-small-font-size=” av-mini-font-size=” icon_size=” av-desktop-font-size-1=” av-medium-font-size-1=” av-small-font-size-1=” av-mini-font-size-1=” color=” custom_font=” subheading_color=” seperator_color=” icon_color=” margin=” margin_sync=’true’ av-desktop-margin=” av-desktop-margin_sync=’true’ av-medium-margin=” av-medium-margin_sync=’true’ av-small-margin=” av-small-margin_sync=’true’ av-mini-margin=” av-mini-margin_sync=’true’ headline_padding=” headline_padding_sync=’true’ av-desktop-headline_padding=” av-desktop-headline_padding_sync=’true’ av-medium-headline_padding=” av-medium-headline_padding_sync=’true’ av-small-headline_padding=” av-small-headline_padding_sync=’true’ av-mini-headline_padding=” av-mini-headline_padding_sync=’true’ padding=’10’ av-desktop-padding=” av-medium-padding=” av-small-padding=” av-mini-padding=” icon_padding=’10’ av-desktop-icon_padding=” av-medium-icon_padding=” av-small-icon_padding=” av-mini-icon_padding=” link=’manually,http://’ link_target=” id=” custom_class=” template_class=” av_uid=’av-kx4q0z2f’ sc_version=’1.0′ admin_preview_bg=”][/av_heading]

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    [av_one_full first min_height=” vertical_alignment=’av-align-top’ space=” margin=’0px’ margin_sync=’true’ row_boxshadow_color=” row_boxshadow_width=’10’ link=” linktarget=” link_hover=” title_attr=” alt_attr=” padding=’50px,5%,50px,5%’ highlight_size=’1.1′ border=” border_color=” radius=’0px’ radius_sync=’true’ column_boxshadow_color=” column_boxshadow_width=’10’ background=’bg_color’ background_color=” background_gradient_color1=” background_gradient_color2=” background_gradient_direction=’vertical’ src=” attachment=” attachment_size=” background_position=’top left’ background_repeat=’no-repeat’ animation=” mobile_breaking=” mobile_display=” av_uid=’av-k0i4yzrj’ custom_class=”]

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    We are proud to announce that one of VALUE-Dx’s publications is the number one most read paper in the BJGP Open in 2022! Our paper on Point-of-care testing, antibiotic prescribing and prescribing confidence for respiratory tract infections in primary care: a prospective audit in 18 European countries tops their Top 10 Most Read Research articles, a wonderful achievement.

    The aim of the study was to describe between-country differences in RTI management, particularly diagnostic testing and antibiotic prescribing, and investigate which factors relate to antibiotic prescribing and GPs’ prescribing confidence. Read the paper here.
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  • WHO AWaRe Antibiotic Book

    WHO AWaRe Antibiotic Book

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    [av_heading heading=’WHO AWaRe Antibiotic Book’ tag=’h3′ style=’blockquote modern-quote modern-centered’ subheading_active=’subheading_below’ show_icon=” icon=’ue800′ font=’entypo-fontello’ size=” av-desktop-font-size-title=” av-medium-font-size-title=” av-small-font-size-title=” av-mini-font-size-title=” subheading_size=’15’ av-desktop-font-size=” av-medium-font-size=” av-small-font-size=” av-mini-font-size=” icon_size=” av-desktop-font-size-1=” av-medium-font-size-1=” av-small-font-size-1=” av-mini-font-size-1=” color=” custom_font=” subheading_color=” seperator_color=” icon_color=” margin=” margin_sync=’true’ av-desktop-margin=” av-desktop-margin_sync=’true’ av-medium-margin=” av-medium-margin_sync=’true’ av-small-margin=” av-small-margin_sync=’true’ av-mini-margin=” av-mini-margin_sync=’true’ headline_padding=” headline_padding_sync=’true’ av-desktop-headline_padding=” av-desktop-headline_padding_sync=’true’ av-medium-headline_padding=” av-medium-headline_padding_sync=’true’ av-small-headline_padding=” av-small-headline_padding_sync=’true’ av-mini-headline_padding=” av-mini-headline_padding_sync=’true’ padding=’10’ av-desktop-padding=” av-medium-padding=” av-small-padding=” av-mini-padding=” icon_padding=’10’ av-desktop-icon_padding=” av-medium-icon_padding=” av-small-icon_padding=” av-mini-icon_padding=” link=’manually,http://’ link_target=” id=” custom_class=” template_class=” av_uid=’av-kx4q0z2f’ sc_version=’1.0′ admin_preview_bg=”][/av_heading]

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    In December 2022, the World Health Organisation (WHO) released the WHO AWaRe Antibiotic Book. AWaRe (which stands for access, watch and reserve) is a concise, evidence-based guide for choosing antibiotics, doses, routes of administration and duration of treatment for more than 30 of the most common clinical infections in children and adults, in both primary health care and hospital settings. For ease of use, the book is also available in the form of infographics and an online web application, which provides a quick-reference guide for health care professionals at the point of care.

    Up until now, easily accessible, evidence-based guidance from trusted sources has been lacking for many common infections in many countries, especially in low- and middle-income settings. The AWaRe antibiotic book is expected to be of particular value in those settings where WHO guidance might be the only high-quality information source available.

    Through the Global Action Plan on AMR, WHO is working to improve the surveillance of antimicrobial resistance and reduce inappropriate antibiotic consumption. VALUE-Dx shares WHO’s concern that antimicrobial resistance poses a threat to public health globally, and contributes to the fight against AMR by validating diagnostics to optimize antibiotic use. Find out more here.
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  • VALUE-Dx gives recommendations for CA-ARTI diagnostics in new report

    VALUE-Dx gives recommendations for CA-ARTI diagnostics in new report

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    [av_heading heading=’VALUE-Dx gives recommendations for CA-ARTI diagnostics in new report’ tag=’h3′ style=’blockquote modern-quote modern-centered’ subheading_active=’subheading_below’ show_icon=” icon=’ue800′ font=’entypo-fontello’ size=” av-desktop-font-size-title=” av-medium-font-size-title=” av-small-font-size-title=” av-mini-font-size-title=” subheading_size=’15’ av-desktop-font-size=” av-medium-font-size=” av-small-font-size=” av-mini-font-size=” icon_size=” av-desktop-font-size-1=” av-medium-font-size-1=” av-small-font-size-1=” av-mini-font-size-1=” color=” custom_font=” subheading_color=” seperator_color=” icon_color=” margin=” margin_sync=’true’ av-desktop-margin=” av-desktop-margin_sync=’true’ av-medium-margin=” av-medium-margin_sync=’true’ av-small-margin=” av-small-margin_sync=’true’ av-mini-margin=” av-mini-margin_sync=’true’ headline_padding=” headline_padding_sync=’true’ av-desktop-headline_padding=” av-desktop-headline_padding_sync=’true’ av-medium-headline_padding=” av-medium-headline_padding_sync=’true’ av-small-headline_padding=” av-small-headline_padding_sync=’true’ av-mini-headline_padding=” av-mini-headline_padding_sync=’true’ padding=’10’ av-desktop-padding=” av-medium-padding=” av-small-padding=” av-mini-padding=” icon_padding=’10’ av-desktop-icon_padding=” av-medium-icon_padding=” av-small-icon_padding=” av-mini-icon_padding=” link=’manually,http://’ link_target=” id=” custom_class=” template_class=” av_uid=’av-kx4q0z2f’ sc_version=’1.0′ admin_preview_bg=”][/av_heading]

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    Antimicrobial resistance (AMR) is a global public health threat which is the cause of numerous deaths and medical complications. One major driver for AMR is the inappropriate use of antibiotics, such as in the treatment of community-acquired acute respiratory tract infections (CA-ARTI).

    In November 2022, Work Package 5 of VALUE-Dx published a report on their 5.4 Deliverable. The aim of the study was to develop recommendations for fit-for-purpose policies in funding and pricing to improve the uptake of CA-ARTI point-of-care testing (POCT) in the outpatient sector. The report presents such policy recommendations, which are supplemented by some additional advice on health technology assessments (HTA) and overarching considerations. 

    One of the goals of Work Package 5 is to review and analyse the current policy environment in Europe and identify good practices for the assessment of innovative diagnostics. WP5 also strives to develop proposals for fit-for-purpose policies, to accelerate market entry of and accessibility to cost-effective diagnostics with the potential to be applied to reduce AMR.

    In the report, a total of fifteen recommendations targeted at policy-makers are proposed. Ten of them have been clustered in the policy areas of HTA, pricing and procurement, and funding. Five additional recommendations refer to overarching aspects that are conducive to the successful implementation of peri-launch policies. Read the report here.

     
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  • Interview with PhD student Juan Pablo Rodriguez Ruiz

    Interview with PhD student Juan Pablo Rodriguez Ruiz

    Interview with PhD student Juan Pablo Rodriguez Ruiz

    Read our interview with PhD student Juan Pablo Rodriguez Ruiz at the Laboratory of Medical Microbiology at the University of Antwerp. He discusses his work with Work Package 2 within Value-Dx, his future tasks and more.

    Juan Pablo Rodriguez Ruiz is a 27-year-old PhD student at the Laboratory of Medical Microbiology of the University of Antwerp. He studies the microbiome of patients suffering from Respiratory Tract Infections and the effect of antibiotic intake in these patients within the VALUE-Dx project. Juan Pablo has a Bachelor in Biotechnology at Universidad Pablo de Olavide (Sevilla) and a Master in Microbiology at Universidad de Granada.

    What does your work for VALUE-Dx entail?

    Juan Pablo: I’m part of Work Package 2 (WP2), the microbiology side of the VALUE-Dx project. We mainly perform substudies derived from the main trials ADEQUATE-paediatric and PRUDENCE in WP4. Within these substudies there is a metagenomics part, revolving around the microbiome related to the antibiotic treatments in the trials. There is also another part revolving around biomarkers but I’m not involved in that. Lastly, we biobank the samples from the trials. My main role is to perform the metagenomics of the microbiology studies in the lab. We sequence the DNA of the samples we receive from the trials and evaluate the effect of the antibiotic treatments.    

    How long have you been working on the project?

    Juan Pablo: Since the start of VALUE-Dx, so about four years ago. In the beginning, I spent a month at the University of Edinburgh, one of the VALUE-Dx partners. They are creating a technical roadmap with recommendations for short- and long-term goals to help companies and research institutions prioritize investment decisions in the field of CA-ARTI diagnostics. In Edinburgh, I did research into companies that are developing new diagnostic tests for respiratory tract infections (RTI).

    Currently, at the Laboratory of Medical Microbiology at the University of Antwerp, my job is to make sure that everything is ready for when the samples arrive. I take care of setting up the DNA extraction and sequencing protocols, the bioinformatics pipeline, etc.         

    What upcoming tasks do you have for VALUE-Dx?

    Juan Pablo: We are in the process of receiving the samples from the trials. Once we receive them, we can start the lab work. In ADEQUATE-paediatric, the patients are children presenting with community-acquired pneumonia in the emergency room. They are randomised to either undergo the diagnostic tests or the usual care. With regards to the substudy in which I am involved, we ask for oropharyngeal samples at the randomization and one month later and we want to see whether the antibiotics that have been prescribed have an effect on the microbiome and the resistance in the oropharynx.    

    PRUDENCE works with patients in long term care facilities. If these patients develop respiratory tract infections they get tested, depending on what group they are randomised in. For the substudy, we take additional samples in order to see the effect of antibiotic prescriptions.  

    What did you find most challenging about the project? What has been the most exciting?

    Juan Pablo: Coordinating a multi-centre, international study is of course very challenging. In my case specifically, the delay of the samples due to the COVID-19 pandemic posed a big challenge. The start of the trial was delayed for more than one year. Now, the recruitment is ongoing so, step by step, we’re getting there. On the other hand, in other work packages, there has already been a lot of work done.  

    For me, it was very exciting to get everything ready for when the samples arrive. This includes preparing the right protocols, sequencing, bioinformatic tools, etc. That was also the upside of the delay, we had more time to put everything together with great care.

    • About Juan Pablo Rodriguez Ruiz

    Juan Pablo graduated as a Bachelor in Biotechnology at Universidad Pablo de Olavide (Seville) in 2016 and as a Master in Microbiology at Universidad de Granada in 2018. As a PhD student at the Laboratory of Medical Microbiology, he studies the microbiome of patients suffering from Respiratory Tract Infections and the effect of antibiotic intake in these patients.

    More interviews

  • Does diagnostic testing always decrease antibiotics prescriptions?

    Does diagnostic testing always decrease antibiotics prescriptions?

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    In August 2022, VALUE-Dx published a new article in the European Journal of Health Economics with the following title: ‘Does diagnostic testing always decrease antibiotics prescriptions?’. The conclusion of this scientific paper is that we should be very careful when we assert that point-of-care diagnostic testing (POCT) reduces antibiotics prescriptions as there are situations in which the opposite effect occurs.

    Why POCT?
    Empiric prescription as a treatment for infectious diseases in community care settings has caused antibiotics to be overprescribed, resulting in an increase of antimicrobial resistance (AMR). In order to reduce antibiotics prescription, point-of-care diagnostic testing (POCT) has been suggested.

    In this new VALUE-Dx article, a stylised static theoretical economic model was used to analyse whether POCT always decreases antibiotics prescriptions. The interaction of a group of doctors who differ in their level of concern about AMR when prescribing with a firm selling a POCT was taken into consideration. The price set by the manufacturer and doctors’ decision to employ POCT was characterised.

    Results of the study
    It is widely accepted that the use of diagnostic testing to guide antibiotics prescription in community care settings reduces the number of antibiotics prescriptions. However, the model used in this article shows that we should be very careful with recommending the use of POCT to reduce antibiotics prescriptions as we may end up with the opposite result.

    In fact, the number of antibiotics prescriptions is not always lower. It depends on the distribution of the doctors’ concern about AMR as there is a proportion of doctors who use POCT and then prescribe antibiotics, while other doctors change their prescribing behaviour after using POCT. They stop giving antibiotics to patients who do not benefit from them. When the proportion of patients who need antibiotic treatment is higher than the proportion of doctors who use POCT and stop prescribing unnecessary antibiotics, the number of antibiotics prescriptions is larger.

    These analyses convey the message that we should be very careful when we assert that POCT reduces antibiotics prescriptions as there are situations in which the contrary effect is produced.

    You can read the publication here.

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  • Interview with Professor Bojana Beović

    Interview with Professor Bojana Beović

    Interview with Professor Bojana Beović

    Read our interview with Professor Bojana Beović from the Ljubljana University Medical Centre. She elaborates on her role in the antimicrobial resistance (AMR) field, the impact of the COVID-19 pandemic on AMR and its research.

    1. What is your role in the AMR field and what does it entail?

    I am the Chair of the Antimicrobial Stewardship Unit at the Department of Infectious Diseases at the Ljubljana University Medical Centre. In addition, I am the chair of the so-called Intersectoral Coordination Mechanism for the Control of Antimicrobial Resistance at the Ministry of Health of Slovenia. This is a multidisciplinary group that manages AMR activities in the country. It includes the medical sector, the veterinary sector, and environmental specialists.

    2. Why should people be concerned about AMR?

    It is a well-known fact that antimicrobial resistance reduces the quality of care. Also in Europe, several analyses showed that AMR places a considerable burden on the healthcare system, including excessive mortality. Especially during epidemics, there was less attention paid to antimicrobial resistance and the conditions in many hospitals did not allow for its control, leading to a sharp increase. We will have to compensate for the loss caused by the COVID-19 pandemic in the coming years. In addition, the attention of the general population and media shifted from AMR to the Coronavirus disease, despite our efforts during the World Antibiotic Awareness Week last November.

    3. What is the expected impact of the work you’re doing?

    I have been working in this field for more than 20 years, and we were able to stabilise antimicrobial use and antimicrobial resistance through various activities. This does not mean that our job is done. I believe that stable daily activities are necessary in order to get the situation under control in a long term perspective. Therefore, in my opinion, the most important achievement is that antimicrobial stewardship is recognised and accepted as one of the normal daily activities in the hospital.

    4. With regards to AMR, what’s the context in your country?

    Eurobarometer data show that awareness of general public has decreased. In 2019, the Slovenian Government adopted a strategy for combating antimicrobial resistance, but because of the pandemic, many activities were not undertaken. The problem is that fighting AMR is a political commitment that is not followed by any funding. In Slovenia, most activities are still voluntary or financed from other sources and there is no financial support for the programmes of the government or the Minister of Health.

    5. How did the COVID-19 pandemic impact the research on AMR?

    It was obviously very difficult to cover the shifts during the pandemic with sufficient staff. Most of the doctors and microbiologists were involved in various COVID-19 activities. However, we were able to carry out two analyses. First, we sent out a survey asking doctors on an international scale whether they prescribed antibiotics to patients with COVID-19. The response from my colleagues in Slovenia showed relatively modest use. In addition, we conducted an international point prevalence study, comparing antibiotic use in COVID-19 patients in the ICU and in ordinary wards in Serbia, Croatia, Slovenia, and Italy. Our results showed that antibiotic use in Slovenia was relatively modest compared to other countries. We do not have data on antimicrobial resistance yet, but we are aware of a number of extremely resistant bacteria that were previously absent from some intensive care units in Slovenia, despite a generally relatively modest use of antibiotics. It is probably a consequence of antibiotic use and poor infection control during the most intensive peaks of the pandemic. 

    • About Bojana Beović

    Prof Bojana Beović, MD, PhD has been employed at the Department of Infectious Diseases at the University Medical Centre in Ljubljana since 1986. Since 2008 she is the head of the Antibiotic Committee in UMC Ljubljana. At the European Society of Clinical Microbiology and Infectious diseases (ESCMID), she was the honorary secretary of the ESCMID Study Group for Antibiotic stewardship (ESGAP) from 2009 to 2014. At the moment, she is the head of the ID Consultancy Service, chairs the Medical Chamber of Slovenia and is full professor of infectious diseases at the Medical School, University of Ljubljana. Her current focus of interest in research is antibiotic stewardship, and antibiotic therapy.

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