More than 700 000 people die per year globally due to antimicrobial resistance (AMR), according to an estimate from the UK government-commissioned review on AMR [1,2]. At the current rate, by 2050, AMR is predicted to cause 10 million deaths annually and cost the world economy $100 trillion in total.
It is widely recognised that rapid diagnostics are crucial in the fight against AMR, to improve the management of life-threatening infections such as sepsis and pneumonia and to enable earlier and more precise targeting of pathogens with appropriate antibiotics (i.e. improved antibiotic stewardship) . The final O’Neill report states that, by 2020, all antibiotic prescriptions should be supported by a rapid diagnostic test, where available.
Margaret Chan, the former Director General of the WHO, stated the following on the subject: “Today, antibiotics are rarely prescribed based on a definitive diagnosis. Diagnostic tests can show whether or not an antibiotic is actually needed, and which one. Having rapid, low-cost, and readily available diagnostics is an essential part of the solution to this urgent problem”.
Wound infections are common complications of acute and chronic wounds. They lead to disruptions of wound healing, irreversible scarring, and increase the risk of sepsis, loss of limb or life . From epidemiological studies, it can be inferred that around 15% of severe sepsis have as primary source an infected wound . Skin and soft tissue infections are among the most common for which antibiotics are prescribed .
Since the ancient times, wound infection has been primarily diagnosed by clinical findings, including redness, warmth, swelling, pain or tenderness and pus or purulent secretions. These clinical signs are often masked or sometimes mimicked because of neuropathy, vascular insufficiency and various types of immunodeficiency. Systematic signs, symptoms or elevated inflammatory markers are often absent and related to other accompanying clinical conditions . Assessments by expert-clinicians are mostly inaccurate, while Untreated wound infections can lead to serious complications. In doubt, health care workers tend to over-prescribe antibiotics contributing to AMR.
The NHS in the UK treats an estimated 3.8 million patients with a wound annually in 2017/2018. Antibiotics are prescribed in all wounds with a suspected infection. As a result, 50% of total wounds are being treated with an antibiotic resulting in around 2 million prescribed antibiotic courses . As it is estimated that 50% of these treatment courses are unnecessary or inappropriate , it can be inferred that more accurate initial clinical diagnosis of wound infections has the potential to reduce antibiotic usage in the UK with 1 million courses annually.
As there exists a high correlation between antibiotic usage and occurrence of resistance , increasing the accuracy of the diagnosis of wound infections will contribute to the global response to AMR.
The SmartWound Rapid Diagnostic / Point of Care Test is a simple tool that improves the clinical diagnosis of wound infections by health care workers. It is being developed to adhere to the REASSURED criteria as postulated by the WHO: affordable, sensitive, specific, user-friendly, rapid and robust, equipment-free or simple, deliverable to the end users, real-time connectivity, and ease of specimen collection .