Kost Gerald J
From Knowledge Optimization, Davis, California; and Point-of-Care Testing Center for Teaching and Research (POCT•CTR), University of California, Davis.
Arch Pathol Lab Med. 2021 Feb 1;145(2):145-167. doi: 10.5858/arpa.2020-0284-RA.
CONTEXT.—: Point-of-care testing (POCT) is inherently spatial, that is, performed where needed, and intrinsically temporal, because it accelerates decision-making. POCT efficiency and effectiveness have the potential to facilitate antimicrobial resistance (AMR) detection, decrease risks of coinfections for critically ill patients with coronavirus infectious disease 2019 (COVID-19), and improve the cost-effectiveness of health care.
OBJECTIVES.—: To assess AMR identification by using POCT, describe the United States AMR Diagnostic Challenge, and improve global standards of care for infectious diseases.
DATA SOURCES.—: PubMed, World Wide Web, and other sources were searched for papers focusing on AMR and POCT. EndNote X9.1 (Clarivate Analytics) consolidated abstracts, URLs, and PDFs representing approximately 500 articles were assessed for relevance. Panelist insights at Tri•Con 2020 in San Francisco and finalist POC technologies competing for a US $20,000,000 AMR prize are summarized.
CONCLUSIONS.—: Coinfections represent high risks for COVID-19 patients. POCT potentially will help target specific pathogens, refine choices for antimicrobial drugs, and prevent excess morbidity and mortality. POC assays that identify patterns of pathogen resistance can help tell us how infected individuals spread AMR, where geospatial hotspots are located, when delays cause death, and how to deploy preventative resources. Shared AMR data "clouds" could help reduce critical care burden during pandemics and optimize therapeutic options, similar to use of antibiograms in individual hospitals. Multidisciplinary health care personnel should learn the principles and practice of POCT, so they can meet needs with rapid diagnostic testing. The stakes are high. Antimicrobial resistance is projected to cause millions of deaths annually and cumulative financial loses in the trillions by 2050.
即时检验（POCT）本质上具有空间性，即在需要的地方进行检测，同时也具有内在的时间性，因为它能加速决策过程。POCT的效率和有效性有潜力促进抗菌药物耐药性（AMR）检测，降低2019冠状病毒病（COVID-19）重症患者合并感染的风险，并提高医疗保健的成本效益。
评估使用POCT进行AMR鉴定，描述美国AMR诊断挑战，并改善全球传染病护理标准。
检索了PubMed、万维网和其他来源，以查找关注AMR和POCT的论文。使用EndNote X9.1（科睿唯安分析公司）对代表约500篇文章的摘要、网址和PDF进行整理，评估其相关性。总结了2020年在旧金山举行的Tri•Con会议上专家小组成员的见解以及争夺2000万美元AMR奖项的决赛入围POC技术。
合并感染对COVID-19患者构成高风险。POCT有可能帮助确定特定病原体，优化抗菌药物选择，并预防过高的发病率和死亡率。能够识别病原体耐药模式的POC检测有助于我们了解感染个体如何传播AMR、地理空间热点位于何处、延误何时导致死亡以及如何部署预防资源。共享的AMR数据“云”有助于减轻大流行期间的重症护理负担并优化治疗选择，类似于个别医院使用抗菌谱。多学科医疗保健人员应学习POCT的原理和实践，以便能够通过快速诊断检测满足需求。 stakes很高。预计到2050年，抗菌药物耐药性每年将导致数百万人死亡，并造成数万亿美元的累计经济损失。 （注：最后一句中“stakes”未准确翻译，结合语境此处大概意思是“风险、利害关系”等，因原文此处表述较模糊，暂保留英文未准确翻译）
