An Extra Tool to Help Towards Better Antimicrobial Stewardship

Antibiotics; a cornerstone of modern medicine that has saved countless lives since that first plate of penicillium mould was investigated by Fleming in 1928, spawned a huge industry of drug companies all racing to find the next great saviour. Unfortunately, as we all know, those pesky microbes have been doing their best to keep up and adapt to each new discovery we add to our arsenal, culminating in a biological arms race that at the moment, seems to be turning in the bugs’ favour. We’ve hit somewhat of a wall in the discovery of new antibiotics, and overuse of the ones we already have is rapidly depleting their effectiveness as more and more resistant strains make their debut on the microbial stage.

The latest attempt to tackle this challenge is to better control what antibiotics we are using and when we use them as part of a wider program known as Antimicrobial Stewardship (AS). In short, AS refers to a series of coordinated interventions to promote the use of only the optimal antimicrobial – with the right dosage, duration and administration method to, amongst other things, try and reduce the rise of resistant strains of micro-organism. This is exactly what UK company Momentum Bioscience Limited is looking to help tackle. Vitl paid a visit to the very enthusiastic Dr Helen Bennett, Customer Support Scientist for Momentum to find out more about their work and how their Ther-Mix programmable heated mixer is helping.

MOMENTUM BIOSCIENCE LTD was founded to develop rapid tests for critically-important clinical specimens within the hospital microbiology laboratory. They have created a new innovative technology for in vitro diagnostic testing – Enzymatic Template Generation and Amplification (ETGA^®). ETGA^® technology rapidly and universally detects viable micro-organisms using a unique combination of a phenotypic marker and ultra-sensitive molecular PCR measurement. Momentum is developing a number of products and applications for the use of its ETGA^® technology.

To give a very brief overview of the process, first a sample is collected from a currently negative patient blood culture that has been incubated for at least 12 hrs on the automated blood culture machine. The sample then has to be cleaned up, using a combination of blood cell lysis and centrifugation, as well as the inactivation of any residual enzymes. This leads to the cleaned up sample which may contain microorganisms to move onto the next step. Now it is the turn of the target organisms to undergo lysis using a mechanical and chemical method, releasing various DNA-modifying enzymes such as polymerases into the environment. A synthetic DNA substrate is added to the sample, and the polymerases dutifully get to work doing what they do best. Following the modification of this new PCR template, a quantitative PCR assay can be performed to amplify the target. If there are no target organisms present in the sample, then there will have been no modified substrate to amplify and therefore no detection from the PCR process, confirming an early negative result for the blood culture the next day.

Of course like any new test, Momentum has taken plenty of time, care and effort to ensure that what their customers will receive does exactly what it says on the tin. The development work up until now has involved a wide array of mixers and hot blocks to carry out the incubation steps. What this has meant is where a mixing step is followed by more than one incubation step at different temperatures; an operator has to be present to move the samples from one environment to the other.

Helen said, “Once you combine that with a busy laboratory running an array of tests at once, it isn’t uncommon to find operators using a few mixers and more than four hot blocks simultaneously, taking up both time, and a good amount of bench space.”

This is where the Ther-Mix has been able to lighten their load. Programmability combined with highly-accurate heating capabilities gives the user tight control over their protocol. Using the Ther-Mix, it became possible for Momentum to combine multiple mixing and incubation steps into one unit, freeing up bench space and allowing operators to walk away, not worry about missing timers going off or moving samples, and to move towards a semi-automated development process.

Momentum are continuing to work on their product development, with Helen becoming rather attached to her faithful Ther-Mix working alongside her, and Vitl waiting in the wings to give input from the instrumentation side of the equation. With any luck, Momentum has found the perfect instrument to streamline their process, and Vitl a new application for this incredible new product.

Hear Dr Helen Bennett discuss her work in this video.