The Future is Diagnostics

On a hot afternoon on the walkway of Mbale Regional Referral Hospital in Uganda, I met John, a 36-year-old man from Busamaga, Mbale. John had a fever and severe abdominal pain. He had gone to the local clinic in the nearest town and was told to purchase medicine for peptic ulcers and painkillers without running any diagnostic tests. His pain continued, and he sought medical assistance from the local health facility. Without any testing, he was given antibiotics due to his clinical history and persistent pain. As his illness worsened, John was referred from one health center to another without success, and health facilities did not have the equipment to diagnose him properly.  Finally, he went to Mbale Regional Referral Hospital and gained access to diagnostic testing. John was diagnosed with intestinal perforation due to Salmonella typhi, a bacterium resistant to most of the antibiotics previously used in the lower facilities where he had been. He required surgery to repair his perforated intestine. John’s life was saved because he was finally able to access adequate diagnostic testing and treatment. The bacteria causing his infection was antimicrobial-resistant. John’s experience with an antimicrobial-resistant infection could happen to anyone.

In my experience as a third-year medical student at Busitema University in rotations in the medical ward and laboratory at Mbale Regional Referral Hospital, I regularly witness treatment failure because of the inaccurate diagnosis of the microorganism causing an infection. People suffering from viral infections are often given antibiotics for weeks only to realize that the cause of the disease is not bacteria. The same problem occurs when treatment targets Gram-positive bacteria when the real culprit is a Gram-negative bacterium*. These inappropriate treatments can be harmful and lead to a loss of time and resources. I have seen clinicians who, for lack of access to diagnostics, prescribe a combination of antibiotics in the hope that one of them will target the microbe causing the ailment.

Concluding that a patient is infected by a drug-resistant bug requires very sophisticated equipment rarely found in the lower-level laboratories accessed by most of the public. While drug-resistant microbes are a global phenomenon, the labs that can diagnose them are few and far between, especially in low- and middle-income countries. We need well-equipped laboratories in all hospitals, with tools that can help medical practitioners differentiate between illness-causing microorganisms, a key to effective diagnosis and treatment that will ultimately lower the burden on people and the healthcare system.

Developing new antibiotics takes a lot of time and resources, but diagnostics can help preserve the effectiveness of current and future ones. For example, rapid identification of a bacterial infection can lead to better antibiotic use, while the identification of drug-resistant bugs in different areas of the hospital environment can be essential in preventing infection from such environments.

Most facilities I have worked at in Uganda depend on patients’ responses to treatment to evaluate the accuracy of diagnoses, increasing the burden on clinicians and the healthcare system. Better access to diagnostics could strengthen the fight against antimicrobial resistance as it promotes the rational use of medications, ensuring patients receive the right drug, at the right dosage, for the right duration, and at the right time.

One patient I encountered, Annet, a 45-year-old mother of five with diabetes, developed a small, infected wound on her right foot that kept expanding. A delay in the diagnosis of the bug causing the infection left her without any treatment options. Our team had to request that her foot be amputated. Improved diagnostics, evaluating how well a treatment works, could help determine when to stop or change antibiotic therapy in cases like Annet’s.

While new diagnostic technology is expensive, improperly diagnosed or non-diagnosed infections are more expensive in the long run. Equitable access to advanced diagnostics and investment in better diagnostics is key to combatting antimicrobial resistance and reducing the burden on healthcare systems and the threat to life and well-being around the world.

* Gram-negative and Gram-positive bacteria are two major types of bacteria distinguished by their cell wall structure and behavior. Knowing if a bacterium is gram-negative or gram-positive helps in choosing adequate treatment for a bacterial infection, as different antibiotics are effective against each group.

Edited by Samantha Serrano