December 2013

“Changing Clinical Practice and Improving Patient Care”

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Punit Kohli, Business Director, BD Diagnostics- BD Diagnostic Systems in India, is a heathcare veteran with infection prevention portfolio. In conversation with Shahid Akhter, ENN, he shares his experience in automated blood culturing and diagnostic solutions that help in better patient management.

Technological advances have given rise to innumerable diagnostic tools. Please tell us about BD’s role in diagnostics?
With the growing incidence of drug resistance, infectious diseases are estimated to be the biggest contributors to the mortality amongst children and young adults. To provide successful treatment, the physicians are looking for diagnostic tools which have quick turnaround time, minimal manual errors and improved recovery rates. Becton, Dickinson (BD), a leading global medical technology company is a pioneer in automated diagnostic solutions and has a history of providing innovative solutions for the better and faster diagnosis and treatment of infectious diseases. The BD BACTEC Systems and Phoenix systems are world-class technologies available in Indian laboratories which are meticulously used to support critical diagnostic requirement of the physicians.

BD has pioneered development and commercialization of the BD MGIT Liquid Culture Systems, which support end to end effective TB diagnosis, drug susceptibility testing and facilitate treatment follow up support. Liquid Culture Automation has now become a gold standard of TB diagnosis, from sampling, culture to drug susceptibility tests.These systems have turned around conventional way of diagnosis of disease and have sufficiently supported superior patient outcomes through channelizing correct data analytics.

‘We have turned around conventional way of diagnosis of disease and have supported superior patient outcomes through channelizing correct data analytics’

Detecting bloodstream infections is an ongoing challenge for healthcare professionals and hospitals despite improvements in testing methods and best practices. Any significant contribution from BD?
Given the prevalence of excessive use of antibiotics in India, most of the patients are already on antibiotics before they show up in a laboratory. This makes detecting bloodstream infections extremely challenging as these antibiotics tend to inhibit true positives or cause delayed diagnosis. This untimely misidentification of the root cause leads to high mortality rates associated with Sepsis. BD has pioneered the use of ‘RESIN TECHNOLOGY’ and has made significant contributions in Changing Clinical Practice and Improving Patient Care december / 2013 ehealth.eletsonline.com 43 overcoming these challenges in Sepsis management.

BD BACTEC system supported by the Resin media enable labs to report out correct results by statistically significantly increasing recovery of pathogen and minimizing turnaround time. In addition to providing world class systems, BD also partners with hospitals and labs in promoting best practices in blood collection for improved treatment outcomes. BD actively engages with  microbiologists and clinicians, through workshops and round table meetings, that offer opportunities for these professionals to deliberate on the challenges in correct diagnosis and treatment of infectious diseases.

 Tuberculosis is India’s major concern. Its diagnosis and identification of clinically appropriate treatment regimens is essential to effectively treat patients, prevent spread of the disease. BD’s breakthrough in this field?
Diagnosis and treatment of TB has become much more challenging today, since the discovery of the resistant forms of the disease – MDR TB and then the more deadly form XDR TB. BD has been making a powerful impact on TB through the introduction of BD BACTEC MGIT Systems, which utilize liquid culture technology. In fact Jasmine Jani, Application Manager at BD Diagnostic Systems was invited to present a paper on rapid drug susceptibility testing of M TB using the MGIT 960 system at the recently held Union meeting in Paris.
Liquid culture is faster, more accurate and more comprehensive than conventional solid media or sputa smear approaches. It is particularly valuable in its ability not only to detect MDR/XDR-TB but also in determining which drugs can be used to treat the patient. It is also more effective than conventional approaches in diagnosing TB in patients co-infected with TB and HIV. WHO in 2007 endorsed liquid culture as a “standard of care” for TB diagnosis and patient management.

Diagnosing and managing sepsis early is very crucial. How diagnostics impact and improve the patient’s outcomes and reducing healthcare system costs?
Sepsis is a disease continuum and quickly progresses from SIRS (Systemic Inflammatory Response Syndrome) to Shock causing high mortality and morbidity in healthcare settings. A positive blood culture is crucial and has diagnostic and prognostic relevance.

At present, with the current practice most of the patients who are suspected of sepsis are put on empirical treatment wherein the clinicians use  their best judgment and put the patients on antimicrobial treatment. Often broad spectrum antibiotics impose the risk of selecting the resistant strains that may multiply and become problem in treatment.

An automated blood culture with capability of recovering organisms in the presence of any level of drugs, plus good clinical sampling practices would be able to achieve true benefit of diagnostic support to patient management. The leadership team at BD Diagnostics (Amit Bhatnagar, Shveta Sharma amongst many) has been involved in shaping educational workshops and programs to ensure the critical care.

 What are the benefits of using sensitive and rapid time-to-detect blood culture systems to enable earlier diagnosis of sepsis?
With various technologies available to healthcare settings, it is of utmost importance to meticulously analyze the appropriateness of the system on various parameters before choosing the right solution fit.

These parameters would ideally include performance of systems on two major fronts – Time to report and Recovery of various pathogens under challenge conditions such as high concentration of antibiotics in samples. BD BACTEC™ systems are proven over the years to support the most superior antibiotic neutralizing devices called BD Resins, which are capable of neutralizing the strongest of antibiotics at trough, mid or peak level of antibiotics.

These systems have far superior performance than other commercially available systems which are easily compromised in recovery rates at mid/peak antibiotic levels. In terms of time to detection, the BD BACTEC system is proven to offer the highest percentage recovery in the first 24 hours as compared to other automated blood culture systems available. BD BACTEC system is capable of recovering 25 percent more positives in day 1 than other automated blood culture systems. This is of great help to clinicians in diagnosis sepsis faster with shortest time to detect positive blood cultures.

BD BACTEC FX series of instruments are the only class of instruments supporting Blood Volume Monitoring Capabilities for samples which effectively support surveillance of cultures and highlight timely interventions as required.

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