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Geospatial Spread of Antimicrobial Resistance, Bacterial and Fungal Threats to COVID-19 Survival, and Point-of-Care Solutions.

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 co-infections for critically ill COVID-19 patients, and improve the cost-effectiveness of healthcare.


OBJECTIVES
To assess AMR identification using POCT, describe the United States AMR Diagnostic Challenge, and improve global standards of care for infectious diseases. Data Sources PubMed, WWW, and other sources were searched for papers focusing on AMR and POCT. EndNote X9.1 (Clarivate Analytics) consolidated abstracts, URLs, and PDFs representing ~500 articles 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
Co-infections 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 healthcare personnel should learn the principles and practice of POCT, so they can meet needs with rapid diagnostic testing. The stakes are high. AMR is projected to cause millions of deaths annually and cumulative financial loses in the trillions by 2050.