NEW YORK (360Dx) – With over 100 million cases a year, urinary tract infections (UTIs) are a leading cause of the world's antibiotic consumption, a problem made worse by the overprescription and incorrect use of antibiotics, indirectly causing an increase in antibiotic-resistant bacteria.
Dependable methods to easily identify bacterial resistance patterns have been a potential solution to the growing UTI issue. This has been infeasible, however, because existing antibiotic resistance tests require days to complete, leaving most clinicians to prescribe antibiotics simply based on clinical symptoms.
Researchers at Uppsala University have now developed a technology to rapidly detect the level of antibiotic resistance or susceptibility in Escherichia coli. Called the fast antibiotic susceptibility test (fASTest), the technology is quick enough to enable a doctor to prescribe patients the correct antibiotics during their first appointment.
Astrego Diagnostics has been spun out to further develop the test for commercial use.
As they reported earlier this week in Proceedings of the National Academy of Sciences, the researchers developed a point-of-care susceptibility test for UTI that does not depend on genotypic results and cultured bacteria growth. Instead, the phenotypic fASTest method relies on sensitive optical and analytical techniques aimed at observing individual bacteria behavior.
Basing their technology on urine samples, the researchers used a custom-designed microfluidic device to monitor individual growth rates of bacteria. The urine sample passes through microfluidic channels, which then trap the bacteria within the chip's multiple rows.
In an interview, Uppsala University professor Johan Elf said the fASTest method is "sufficient to capture a couple hundred of bacteria, aligned in the device so that we can image them directly. After they grow, we apply antibiotics and monitor the growth response directly by looking at the length extension of individual cells."
In the research, the average growth rate of the bacteria, with and without the candidate antibiotics, was calculated in real time. Antibiotic-resistant bacteria continued to grow along in the channels; however, if they were susceptible to the target antibiotics, their growth rate rapidly diminished. Depending on how much each cell’s growth rate slowed and deviated from the untreated reference population, researchers could visually ascertain whether or not specific antibiotics were still effective in the doctor's office.
In the study, researchers recorded the antibiotic response time of E. coli to nine different antibiotics that are used for UTIs, detecting if a bacterial isolate was phenotypically susceptible to an antibiotic in less than 10 minutes. When they included the time for loading a urine sample, the overall test required less than 30 minutes, more or less a requirement for a point-of-care application in a clinical situation.
"We hope that we can reduce the use of some antibiotics while extending the use of some antibiotics that have resistance," Elf said.
He believes that the technology will help stem the development of antibiotic resistance by assaying the susceptibility profile of the bacteria before clinicians initiate treatment, allowing the diagnostic information to guide the choice of antibiotic. In turn, the process would extend the shelf life of older drugs and reduce dependence on newer drugs.
Marketization
Astrego Diagnostics, a Sweden-based startup founded specifically to commercialize the fASTest technology, is currently developing the detection method into a user-friendly product called the qUTI system. According to the company, qUTI will provide patients with effective antibiotic prescriptions at their first consultation.
While the fASTest technology could potentially see usage in other markets involving bacterial contamination, including sepsis and mastitis, Astrego CEO Ove Öhman believes that the company should primarily address the UTI market for the time being.
"We know it's a big market, we know that plenty of patients suffer from prolonged treatment due to the fact that they have to deal with antibiotic resistance," Öhman said in an interview. "There's a real need for something quicker, and this stuff does the job."
Astrego does not currently have a set price for the qUTI product. While qUTI is in its early stage of development, Astrego hopes to set a competitive yet low price that allows the device to become a standard piece of equipment in primary clinics.
The company plans to work with larger players to break through the market's bottleneck and produce a final product within the next few years. Öhman could not provide a timeline for when the technology could become commercially available at this time.
"[qUTI's] not really novel technology in of itself, it's just a smart way of using existing technology for this purpose," Öhman added.