Interview with Vincent J. LaBombardi, Ph.D.
Carbapenem-resistant Enterobacteriaceae, or CRE, have been called, “nightmare bacteria,” because the multi-drug-resistant infections are so difficult to treat and can be deadly in up to 50% of cases, according to the Centers for Disease Control and Prevention (CDC). These bacteria produce an enzyme called carbapenemase that breaks down carbapenem antibiotics, rendering the drugs ineffective. The CDC classifies CRE as an “immediate public health threat that requires urgent and aggressive action.”
Vincent J. LaBombardi, Ph.D., is the Director of Microbiology at New York-Presbyterian Queens. He is a member of the council and two-time past president of the New York City branch of the American Society for Microbiology. Dr. LaBombardi has focused his research on reducing the time it takes to identify infections like CRE in order to treat sepsis patients faster. He has also focused on reducing the use of broad spectrum antibiotics while waiting to generate a precise identification of the pathogen and its resistance patterns.
According to LaBombardi, diagnostic tools are available to help identify and treat sepsis quickly, as well as to curb the misuse of antibiotics.
“The key to fighting sepsis in the age of resistance is smart use of the tools at our disposal that enable us to quickly ascertain sepsis risk, identify the specific pathogens causing the infection, and match the most appropriate antimicrobial,” wrote Dr. LaBombardi in his 2014 paper, “Sepsis and antibiotic stewardship: the importance of rapid ID, rapid AST and right drug-bug match.”1 That continues to hold true today.
Rather than rely exclusively on overnight incubation, which adds a day or more to generate a precise identification of an infection and delays appropriate therapy, Dr. LaBombardi has pioneered the innovative use of automated antimicrobial identification systems for both pathogen ID and antimicrobial susceptibility testing.
“Before I came to New York-Presbyterian Queens, my team at my previous lab had a great deal of success through streamlining the system’s workflow. We were able to significantly reduce the time it took to transition patients away from empiric antibiotics [the doctor’s educated guess in the absence of complete information] to targeted therapy [drugs that treat a specific microbe or group of microbes]. One of the ways we did this was by loading samples into the system throughout the day instead of loading all cultures by batch at the end of the shift,” said Dr. LaBombardi.
The growing incidence of sepsis, along with the growing population of vulnerable patients, has made condensing the time to pathogen identification all the more vital, according to Dr. LaBombardi.
“Add to this the serious problem of antimicrobial resistance, we no longer have the luxury of trial-and-error drug selection. Patients must receive optimal antimicrobial therapy as soon as possible.
“We also saw the need for expedited reporting of results, especially results for drug-resistant organisms. We utilized a facet of our microbial identification technology called auto-posting,” wrote Dr. LaBombardi.
Here is how Dr. LaBombardi describes his expedited auto-posting process:
- An isolate is identified.
- Antibiotic susceptibility tests are completed.
- These two results are then analyzed through the system to confirm the drug-bug match.
- Results are then automatically posted to the laboratory information system (LIS) and to the hospital information system (HIS), effectively sharing the results with the lab and clinical teams simultaneously.
“With this process, we can post an actionable result the same afternoon the isolate is identified, which obviously has tremendous impact on patients at risk for sepsis. We can also alert our peers in Infection Control when patients with multidrug resistant organisms (MDRO) are identified.”
Prior to this automated improvement, called, “Drug-Bug Match Auto-Posting,” Dr. LaBombardi said the lab documented that 36% of all Klebsiella pneumoniae isolates in the hospital were resistant to carbapenem. After a year of implementing the auto-posting protocol, they reduced carbapenemase-producing Klebsiella to 23%.
References:
- Sepsis and antibiotic stewardship: the importance of rapid ID, rapid AST and right drug-bug match. http://www.mlo-online.com/articles/201404/sepsis-and-antibiotic-stewardship-the-importance-of-rapid-id-rapid-ast-and-right-drug-bug-match.php\
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