ESR 2.2
Rapid personalized molecular detection and cost/benefit in patient care

Project

The last few years, rapid molecular diagnostic technologies have, and still are, increasingly enabling clinicians to detect acute infections while the patient is still at the emergency room. Lessons learned and questions raised from these ameliorated techniques and procedures have resulted in the recognition of the significance of diagnostic stewardship. This concept together with the already prominent principle of antimicrobial stewardship has been studied and implemented to a large extent in the UMCG. Adding infection control stewardship to these two areas, the AID stewardship model has been introduced, which reflects the aim of the Medical Microbiology department of the UMCG to perform the correct diagnostic tests, in order to treat the patient optimally and to prevent the transmission of infections. The notion of €hour defines the relationship between costs and benefits of medical microbiological diagnostics within the AID principle. This notion provides an instrument for demonstrating that the costs and benefits of diagnostics may be disconnected within healthcare settings, but they are nevertheless benefiting the same patient through AID stewardship.

Furthermore, implementing improved rapid technologies, we have shown the added value of genotyping several viruses. This not only allowed us to expose transmission patterns, but also led to the identification of viruses which were not previously known to circulate in Europe. Main focus of this project is to develop techniques and strategies which will aid in the rapid characterization of picornaviruses, including enteroviruses and rhinoviruses, and noroviruses. These viruses are highly contagious and capable of causing significant morbidity. Although both virus-groups can be transmitted in the community as well as in hospital settings, picornaviruses are first and foremost community pathogens, while noroviruses are principally nosocomial pathogens. By studying the genotypic epidemiology and the sequence variations of picornaviruses and noroviruses, we aim to achieve better understanding of how transmission can be reduced, but also to identify those viruses which are may become a threat to our patients’ health in the near future. Developing cost effective and rapid tests will be an aspect of this project. Collaborations will be with industries involved in the development of these rapid molecular diagnostic portfolios, which we call Point-of-Impact technologies, as well with software developers who will participate in the development of the economic models.

Supervisors

  • Prof. dr. H.G.M. (Bert) Niesters, PhD. Molecular Medical Microbiologist and professor in Molecular Clinical Virology, and dr. C.C. (Coretta) Van Leer-Buter, MD, PhD. Medical Microbiologist/Virologist. Department of Medical Microbiology, Unit Clinical Virology.

Collaborations

LabHelp automation, the Netherlands
University of Lyon, France

Relevant publications

  1. Van Leer-Buter CC, Poelman R, Borger R, Niesters HGM. Newly identified Enterovirus-C genotypes, identified in the Netherlands through routine sequencing of all enteroviruses detected in clinical materials from 2008 to 2015. J Clin Microbiol. 2016 Jun 29.
  2. Poelman R, Schuffenecker I, Van Leer-Buter C, Josset L, Niesters HGM, Lina B, et al. European surveillance for enterovirus D68 during the emerging North-American outbreak in 2014. J Clin Virol. 2015 Oct;71:1–9.
  3. Dik J-WH, Poelman R, Friedrich AW, Panday PN, Lo-Ten-Foe JR, van Assen S, et al. An integrated stewardship model. Future Microbiol. 2016 Jan;11(1):93–102.

Keywords

Point-of-Impact testing, cost/benefit, diagnostic stewardship.