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AMR Interview with H. Hermann Droest
Current position: Head of Business Line Primary Care & Essential Healthcare
Former positions: Director Marketing at a Point of Care subsidiary, Hitado, Germany
H. Hermann Droest is Head of Primary Care & Essential Healthcare at Sysmex Europe SE. With more than 30 years of experience in the IVD area he gained a profound understand of requests from the lab and clinicians. In the past 10 years he has focussed on Point of Care Testing and established the business unit with the aim to provide high-quality products and provide innovative solutions for near patient testing.
Can you tell us a little bit about why the topic of Primary Care and infections plays a role in your work at Sysmex?
Yes of course, I'd love to, I have been working in the diagnostics industry since 1987 and I am involved in a wide variety of tasks in this area. For more than 10 years I have been dedicated to the topic of Point of Care Testing (POCT), which is incredibly exciting and one of the most innovative areas in diagnostics. Actually, POCT is a diva within the diagnostic world. Since I first heard about it – and that must have been over 20 years ago – it has been hyped up and huge growth opportunities are predicted, but in reality, the market is developing steadily and rather slowly.
This is because many people have still not understood that the aim is not to miniaturise and replace the laboratory, but rather to bring diagnostics to the point of care, where decisions have to be made promptly for various reasons. Be it simply patient convenience, workflow improvement or speed for result. This is especially true for infections, especially acute infections. In these situations, doctors need rapid diagnostic support and this is what we are working on.
Sysmex Europe is involved in the WHO AMR campaign with the slogan ‘AMR fighter’. What can the Primary Care & EHC (essential healthcare) business unit contribute?
First of all, we should take a closer look at this whole approach. In my opinion, the WHO is primarily concerned with adequately addressing current and future problems in the treatment of infections. This includes not only education on how to avoid infections, but above all, improved treatment management in humans and animals and better diagnostic tools. And what is equally important for the WHO is that all people have access to the necessary information, treatments and tools.
For us as an IVD (in vitro diagnostics) company, the focus is on the diagnosis and monitoring of infections and we can offer dedicated solutions for this. Particularly in the immediate diagnosis close to the patient, we can help with various tests to make the diagnosis more precise and enable a targeted treatment of the infections. After all, it is precisely in the area of infection treatment that many therapeutic decisions are made on the basis of symptoms, which may lead to wrong decisions.
Just one example: a study conducted by the Bertelsmann Foundation1 in 2012 shows a frighteningly high number of antibiotic prescriptions for children with middle ear inflammation (otitis media), although the disease is often caused by viruses. If the C- reactive Protein (CRP), an infection marker, was measured before a prescription is made, a more targeted therapy could be carried out together with the medical history. If the results of the CRP measurement are immediately available, immediate therapy can be initiated.
What role do such patient-based tests play today in the field of infections?
Well, we already provide some tests, besides urine dipsticks and evaluation systems for the primary care sector, and including POC tests for infections. Also, a suitable haematology 3-part diff system can provide indications of a possible infection with determining parameters like leucocyte counts. And beside lateral flow tests for viral infections such influenza, RSV, etc., we have quantitative C-reactive protein and procalcitonin available on some POCT devices. However, there are still major hurdles to overcome.
Although the reasonable use of POC tests is undisputed, there is still resistance against it, be it quality concern or simply a low reimbursement which does not cover the expenses for a test. If, however, test costs were compared with the overall savings made by a targeted and rapid treatment, the efforts for unnecessary or incorrect treatments would certainly be drastically reduced. But because antibiotics are so cheap and available nearly everywhere, a POC test is considered more expensive. And the Health Care providers neglected to include treatment costs to account for the possible increase of so-called superbugs.
Does that imply that if we had such tests widely available today, would the issue of AMR be solved soon?
No, of course not, because these AMR problems are complex. But as part of the diagnostics industry, we can already significantly rationalise the use of antibiotics. However, many available parameters are currently only surrogate markers, meaning indirect evidence of an infection is available. Therefore, a stepwise diagnostic is very helpful. This can start quite trivially by firstly only differentiating between the type of infection, bacterial or viral and in further steps, the doctor can then find out the origin of the infection, the pathogen and which medication should be given specifically and in which dose against the relevant pathogen. By the way, this kind of differential microbiology diagnosis is already available but is time-consuming and therefore only recommended in dedicated situations.
Using a POC tool could really be a game-changer in already treating patients with antibiotics at a general practitioner. I would like to emphasise again that such diagnostic tools belong exclusively in the hands of healthcare professionals and should not be used by laypersons or even patients.
Even when the test is very simple, there is always a danger of wrong results interpretation. It is very important to acknowledge that a test results is never a final diagnosis and has to be seen in accordance with patient anamnesis. Today this is still a major task of healthcare professionals.
What do you think Sysmex can do in the future to take the next steps in the development of diagnostic tools?
I think we are only at the beginning of a concrete development of diagnostic tools. By the way, I like the term ‘diagnostic tools’ much better than ‘laboratory tests’ because what we want in the future is to support the clinician and physician both in making a diagnosis and in deciding on a therapy. And because in the future we will be able to do a lot of things that we cannot even imagine today. In the long term, it will certainly be possible to help patients with digital tools like artificial intelligence who do not have direct access to the healthcare system.
But in the medium term we will bring small, compact devices onto the market which will be able to tell them not only the pathogen, but also directly which effective antibiotics they can use in the event of a bacterial infection and in what dosage the antibiotics can be used. And we will be able to have this answer not only after several days, but within half an hour.
Additionally, we have to work on better prognostic tools for severe infections, not only based on scores but on novel biomarkers to start a treatment as early as possible. This will truly save lives and will have a drastic impact on such severe cases. Here we need to work very closely together with the clinicians, not only to understand the root cause of a specific infection but to provide those doctors with suitable tools. They know what is required and we know how to develop those tools, which is in the end a win-win-win situation, for the patient, for the professional user and for us as a diagnostic development company to light the way with diagnostics.
 Bertelsmann Stiftung (2012): Faktencheck Gesundheit Antibiotika-Verordnungen bei Kindern