My name is Jose Alexander. I'm a medical microbiologist. My main role is being the clinical microbiology director for the AdventHealth Orlando system in Central Florida. Part of my work is being the technical director overseeing the activities of the microbiology, virology, and immunology department and also being a clinical consultant for physicians and pharmacies.
So one of my main roles, part of my work in antimicrobial resistance, is to provide rapid and accurate identification of resistant organisms. So these actually enable pharmacy and infection disease physicians to be able to provide appropriate and optimized treatment with these patients. So we've been creating protocols working to be able to create procedures to be able to rapidly identify, provide an accurate and reliable result based on resistant mechanism, and be able to trigger treatment protocols based on that response.
The impact of the COVID-19 pandemic in antimicrobial resistance can be seen from a different perspective. Especially in the beginning of the pandemic when most of the people and actually the hospital were focusing on patients that were being diagnosed with COVID-19, we could see a decrease in the number of admissions besides patient with COVID-19. So this produced a decrease in the positive rate of resistant organisms. And even in patients with COVID-19, patients that were in critical care, patient in ICU, we actually didn't see an increase on detection of multidrug-resistant organisms. So I haven't seen a significant impact on antimicrobial resistance based on the pandemic.
The impact of beta-lactamases and the use of antimicrobials is very important, especially since beta-lactamase is considered the first-line or the most important family of antimicrobial that is commonly used initially in many patients. Being able to identify beta-lactamases is one of the important steps to be able to guarantee that these beta-lactamases are going to be successful or we're going to be expecting a successful clinical outcome in those patients. So this is why it's critical that identification of beta-lactamases, we probably are focusing more on extended-spectrum beta-lactamase, a third-generation, fourth-generation cephalosporin, carbapenems is critical because we want to be able to target and avoid those antimicrobial that we know that could be resistant with a particular resistant mechanism of beta-lactamase.
Phenotypic tool for the identification of antimicrobial resistance is one of the many tools that we have in the laboratory. I think the main phenotypic tool that we actually have access to is to have accurate antimicrobial susceptibility testing, especially if we consider microbial dilutions. The others are other rapid tests or based on non-molecular assays that can allow identifying generic beta-lactamases as ESBL or carbapenemases.
Predicting resistant mechanisms is probably one of the important roles the microbiology laboratory is performing. I don't know until what point is actually a prediction, but we can use data from knowing the organism itself, the intrinsic resistant mechanisms plus previous data to how that organism normally behave with acquire mechanism and being able to evaluate and see what will be the evolution of this organism especially in patients receiving multiple courses of treatment.
One important thing with phenotypical detection, especially when we use microbial dilution, is to be able to have an accurate microbial dilution, especially an MIC distribution, that can help us to identify mechanisms that probably are now going to be able to be identified by other phenotypic tests. The accuracy of the MIC report is highly important especially since these are the base of antimicrobial treatment. But also not only by the base antimicrobial treatment but also can be the initial evaluation and screening of organisms that could be suspicious to carry a major resistant mechanism.
So being able to identify these patterns by microbial dilution if the organism is ESBL-carrying organism or is a potential carbapenemase. So having these accurate MIC distributions at the point that the amount of error viability can be reduced to a point that makes it more reliable is critical.
The goal of antimicrobial stewardship is to prevent the spread of antimicrobial resistance but also to make use of antimicrobial on the best way possible. So one of the roles in antimicrobial stewardship is also the involvement of infection prevention. So we need to make sure that the organism can be accurately identified in a rapid manner, so this patient can be put in isolation, and we can put measures around these cases and avoid that these particular resistant mechanisms continue expanding. I think my point is I would like part of the work that we do, the work that my team in the laboratory is doing is to promote and being able to alert and teach microbiology personnel and scientists to be able to implement more active screening process using the tool that the laboratory already have and being able also to work with the industry to develop new tools to be able to identify these mechanisms.
