An £8m breakthrough prize in the fight against superlice has been awarded, after a decade-long search for a winner, to a test that can identify how to treat a urinary tract infection in 45 minutes.
The test could herald a “sea change” in antibiotic use, the judges said as they announced the winner of the Longitude Prize for Antimicrobial Resistance (AMR).
AMR, where the drugs used to treat infections no longer work, is a growing concern. It kills nearly 1.3 million people worldwide each year and is predicted to cause 10 million more. deaths a year by 2050.
Between 50% and 60% of women will experience at least one urinary tract infection (UTI) in their lifetime, and to half of the bacteria that cause the infections are resistant to at least one antibiotic. The infections can be potentially fatal sepsis.
However, a lack of good, rapid tests means doctors often have to diagnose an infection based on symptoms and guess which antibiotics will work. The inappropriate use of antibiotics drives resistance by giving bacteria opportunities to adapt to evade them.
The Longitude price is set in 2014 to instigate a “cost-effective, accurate, rapid and easy-to-use test for bacterial infections that will allow healthcare professionals worldwide to administer the right antibiotics at the right time”.
The win Sysmex Astrego’s PA-100 AST system is based on technology from Uppsala University in Sweden. A 400 microliter sample of urine is placed on a phone-sized cartridge and then into a shoebox-sized analyzer unit. It can detect bacterial infection within 15 minutes, and identify the antibiotic to treat it within 45 minutes.
Previously, doctors sent a sample to a lab for testing with results within 24 hours, giving a turnaround time of two or three days.
Dr Tom Boyles, an infectious diseases consultant at Johannesburg’s Helen Joseph Hospital who was one of the judges, said most UTIs in South Africa were treated without a sample being sent, due to time and expense.
“As a result, any patient who does not have a UTI at all receives unnecessary antibiotics, and we ‘shoot blind’ when a UTI is present, and as such we must use broader spectrum antibiotics than would otherwise be necessary. . If we have access to this test, we can solve both problems,” he said, adding that it could be used “in many low-resource settings that can afford it and have a power supply.” He described the test in its current form as a “iPhone One” described.
“It has the potential to make great progress,” he said. “I’m sure the prize money will be used to upgrade it to an iPhone 10.”
Dr Sherry Taylor, an NHS GP partner in London, said access to the test would ‘revolutionise’ patient care in the UK, where laboratory tests take “about three days”.
About a quarter of infections are resistant to older antibiotics, which have been withdrawn from general use as a result. The test opens up the possibility that those antibiotics could be brought back.
Dame Sally DaviesA Longitude committee member, the UK’s special envoy on AMR and a former chief medical officer of England, said: “We can no longer afford to prescribe antibiotics ‘just in case’.
“The Longitude award-winner lays the groundwork for a sea change in how we manage these precious medicines, where healthcare professionals are supported with rapid and relevant diagnostic tests to make the best decisions for their patients.”
Mikael Olsson, a co-founder of Sysmex Astrego, said the product is being launched in Europe, but the prize funds will be used to drive work with affiliates in Ghana, Burkina Faso and South Africa and reduce manufacturing costs.
The test costs around £25 for one cartridge in the private sector, but industry experts say adoption in the public sector and high-volume production could see that drop.
Dr Katherine Keenan from the University of St Andrews in Scotland has researched UTIs in Kenya, Tanzania and Uganda. She said the numbers recorded in clinics are “the tip of the iceberg”, with many sufferers buying antibiotics from pharmacies, and that the risk of UTIs is higher in countries with poor sanitation.
Keenan said equitable access is key, with medical advances often prohibitively expensive.
However, if it becomes cheap enough for public health facilities or pharmacies, “there’s no reason why it can’t be effective and really, really, really useful,” she said.
