Randox Health partners with REVIV
Randox Health partners with REVIV
Randox Health have entered into an exciting new partnership with REVIV
Randox Health Clinics are pioneering preventative health care, bringing the world’s most advanced and personalized health programs directly to the public – with the goal of harnessing the power of testing and data to shift healthcare away from sickness management and towards a more proactive approach.
This partnership with REVIV, who championed commercialised IV therapy, will allow people to see real-time results from taking steps to protect their health and to experience the future of wellness.
The IVD drip therapies include:
- The Megaboost, that was designed with wellness in mind this infusion is packed with B vitamins, Vitamin C, Antioxidants and minerals to accomplish restoration of the body’s essential nutrients in one drip.
- The Miniboost, similar to its larger counterpart, the Megaboost, this Miniboost is not to be underestimated! Containing B Vitamins, Vitamin C and antioxidants, it can support energy levels and the immune system whilst aiding protection against cell-damaging free radicals.
- The Royal Flush which supercharges recovery and nutritional balance by providing the ingredients you need directly into your bloodstream. This all-in-one infusion has been directly designed to rehydrate, decreame inflammation and aid detoxification.
- The Hydromax IV which aims to replenish your body’s salts and water.
- The Vitaglow can support detoxification of free radicals that accumulate in the body from exposure to pollutants, daily stresses and chemicals including pesticides.
- The Ultraviv and The Ultraviv pro, both recovery infusions. The Ultraviv can be used to aid recovery against the common cold, sore throats and even the after effects of alcohol. The Ultraviv pro combines a number of prescribed medications with essential vitamins and nutrients delivered alongside the maximum of hydration.
A full list of all REVIV drip therapies and IM booster shots will be available in the Randox Health clinics.
On REVIV partnering with Randox, David Ferguson, Chief Operating Officer, said: “Over the past few years, we’ve seen a dramatic change in people’s behaviours as they seek to understand their health and wellbeing better. At Randox Health, we provide a range of specialised health packages that enable you to take control of your health.
“Our innovative diagnostic technologies can deliver hundreds of results to give you a comprehensive overview of your health and help detect the earliest signs of illness. Collaborating with REVIV is a natural next step, combining our world-class diagnostic services with REVIV signature IV therapies to help our customers protect their current and future health.”
For more information please contact us at: marketing@randox.com
Medical Laboratory Professionals Week 2023
Medical Laboratory Professionals week is taking place from 23rd – 29th April 2023. This is an annual celebration to highlight and acknowledge the contribution of medical laboratory professionals and pathologists to medicine and healthcare. Whether carrying out routine testing or performing vital analysis during states of emergency, patients around the world rely on the hard work and dedication of medical laboratory professionals.
Medical laboratory professionals’ and pathologists’ work often goes unnoticed due to the ‘behind the scenes’ nature of their activities, but today we would like to shine a light on their work and highlight the importance of these individuals to medicine and global health. The role laboratory professionals play in healthcare cannot be understated and Randox would like to give thanks to those around the world who undertake this responsibility every day.
For most people, the process after a sample is taken is largely enigmatic. Therefore, we at Randox would like to elucidate the processes involved and the considerable effort displayed by laboratory staff.
After a sample is taken, it is then transported to a laboratory. Even this supposedly simple process requires careful consideration to ensure the sample is suitable for testing upon reaching the laboratory. Once received, laboratory staff carry out quality control checks to ensure the instrumentation to be used is functioning correctly and providing accurate results. The quality control procedure will differ depending on the scientific discipline but some form of validation of the test process is always required.
Once accurate and robust sample analysis has been carried out a pathologist examines these results or data and works to form a diagnosis. Using this diagnosis, a suitable therapeutic strategy can be determined and administered.
Test results are a major factor in a clinician’s decision for diagnosis and treatment, with 70% of all medical decisions being based on laboratory results. This demonstrates why diagnostics are so important and why Randox believes in celebrating those who make it happen.
As a major contributor to the diagnostics and healthcare industry, we are keenly aware of how important and hard-working medical laboratory professionals are, and the value they bring to the world. This week you’ll find articles featuring a short interview with a medical laboratory professional and a short educational piece on pre-analytical errors.
We hope everyone shares our enthusiasm for celebrating medical laboratory professionals and would like to thank all those who work tirelessly in medical laboratories around the world.
How can Randox help?
Randox Sales Reps are experts in their fields and are available to discuss your specific requirements.
Simply send us an email by clicking the link below and we will get in touch!
The Importance of Maintaining Regular Dietary Patterns to reduce CVD risk
Cardiovascular disease (CVD) is the leading cause of mortality worldwide. An estimated 17.9 million people died from some form of CVD in 2019, accounting for 32% of all-cause mortality that year1. Associations between diet and risk of cardiovascular complications have long been established, largely relating to alterations in lipid profiles.
For as long as anyone can remember, breakfast has been considered the most important meal of the day. Previous studies2 have shown an association between skipping breakfast and increased CVD risk prompting recommendations that up to 30% of one’s daily energy intake should be consumed during the first meal of the day. It has been reported that over 25% of adults skip breakfast. These individuals are often socioeconomically disadvantaged, shift workers, individuals who work particularly long hours, those who suffer from depression or those with poor health literacy2. Another study3 showed that skipping breakfast, when compared with consuming a high-energy breakfast, was associated with a 1.6x and 2.6x higher probability of non-coronary and general atherosclerosis respectively, when all other CVD risk factor had been controlled. This suggests a close relationship between eating breakfast and reducing CVD risk, however, the mechanisms and magnitude of this relationship are poorly understood.
Small, dense low-density lipoprotein cholesterol (sdLDL-C) is a smaller form of LDL-C which boasts greater propensity for uptake by arterial tissue, increased proteoglycan binding, and increased susceptibility for oxidation4. sdLDL-C concentration is strongly associated with CVD risk, yet once again, the mechanisms of this association remain enigmatic. It is thought that all of the metabolic changes associated with alterations in sdLDL-C concentration collectively contribute to the increased risk of CVD, with the main drivers being its propensity for uptake by arterial tissues and its long circulatory stability4
Skipping breakfast and sdLDL-C
A recent study investigated the relationship between skipping breakfast and the effects on lipid parameters5. In a cohort of around 28’000 people from the Japanese population, this study looked at the several markers, including sdLDL-C, to develop an understanding of the importance of regular dietary patterns for reducing the risk of CVD.
The study participants were divided into two main categories: breakfast eaters and breakfast skippers. These categories were further subdivided to differentiate men and women, over and under 55 years old, and those who eat staple products (rice, pasta, bread, etc.) and those who did not. The participants contributed blood samples which were tested for several cardiovascular biomarkers: Creatinine, Liver ALT, Total Cholesterol, Triglycerides, direct LDL-C, HDL-C and sdLDL-C.
They found that around 26% of men and 16.9% of women skipped breakfast regularly. Of these, most were considered young and had significant increases in concentration of triglycerides, LDL-C and sdLDL-C compared with those who ate breakfast almost every day.
Table 1. Median concentration of triglycerides, LDL-C, and sdLDL-C for breakfast skippers and eaters5
| Analyte | Breakfast Skippers (mg/dL) | Breakfast Eaters (mg/dL) |
| Triglycerides | 103 | 93 |
| LDL-C | 124 | 122 |
| sdLDL-C | 34.7 | 32 |
This investigation also revealed that in this cohort, 20% of men and 27.3% of women did not regularly consume staple foods as part of their diet and had higher median sdLDL-C concentration.
Table 2. Median concentration of sdLDL-C in men and women who eat or skip staple food products in their diet5
| Gender | Staple Skippers (mg/dL) | Staple Eaters (mg/dL) |
| Men | 34.1 | 31.6 |
| Women | 25.8 | 24.7 |
The data from this study supports the finding that individuals who skipped breakfast had higher sdLDL-C concentrations than those who ate breakfast consistently. Skipping breakfast can therefore be associated with troublesome lipid parameters in both genders and all age groups in the Japanese population. This study suggests that eating breakfast every day is crucial to maintain beneficial lipid parameters and reduce the risk of developing CVD.
The data also show that individuals who skipped staple foods in their meals presented with higher concentrations of sdLDL-C and a higher sdLDL-C/LDL-C ratio, in men and postmenopausal women, when compared with those who included staple foods in their meals. It is becoming increasingly common to remove staple foods from one’s diet due to their high carbohydrate content and the prevalence of low-carbohydrate diets. This data exhibits the importance of maintaining a nutritionally balanced diet to help reduce the risk of developing CVD.
As the first large scale study of its kind, this analysis provides clear insight into the increased risk of CVD associated with not only skipping breakfast, but failing to maintain a nutritionally balanced diet. The major limitation of this analysis is that it only includes individuals from the Japanese population and the same affects may not be seen in populations from other ethnicities. Therefore, further in-depth analysis is required to confirm these findings in other ethnicities
Randox sdLDL-C Assay
The Randox sdLDL-C assay employs the clearance method which displays good correlation with the gold standard in sdLDL-C quantification, giving laboratories increased confidence in their results first time, every time. Supplied as liquid ready-to-use reagents, this this test can be applied to a wide range of clinical chemistry analysers, producing results in as little as 10 minutes. Relevant controls and calibrators are also available from Randox as part of the Acusera range.
Randox sdLDL-C Assay Key Features
- Direct, automated test for convenience and efficiency.
- Rapid analysis results can be produced in as little as ten minutes, facilitating faster patient diagnosis and treatment plan implementation.
- Liquid ready-to-use reagents for convenience and ease of use.
- Applications available detailing instrument specific settings for a wide range of clinical chemistry analysers.
- sdLDL-C controls and calibrator available.
References
- World Health Organization. Cardiovascular Diseases. World Health Organization. Published June 11, 2021. https://www.who.int/news-room/fact-sheets/detail/cardiovascular-diseases-(cvds)
- Ofori-Asenso R, Owen AJ, Liew D. Skipping Breakfast and the Risk of Cardiovascular Disease and Death: A Systematic Review of Prospective Cohort Studies in Primary Prevention Settings. Journal of Cardiovascular Development and Disease. 2019;6(3):30. doi:https://doi.org/10.3390/jcdd6030030
- Uzhova I, Fuster V, Fernández-Ortiz A, et al. The Importance of Breakfast in Atherosclerosis Disease. Journal of the American College of Cardiology. 2017;70(15):1833-1842. doi:https://doi.org/10.1016/j.jacc.2017.08.027
- Rizvi AA, Stoian AP, Janez A, Rizzo M. Lipoproteins and cardiovascular disease: An update on the clinical significance of atherogenic small, dense LDL and new therapeutical options. Biomedicines. 2021;9:1579. doi:https://doi.org/10.3390/biomedicines9111579
- Arimoto M, Yamamoto Y, Imaoka W, et al. Small dense low-density lipoprotein cholesterol levels in breakfast skippers and staple food skippers. Journal of Atherosclerosis and Thrombosis. 2023;30. doi:https://doi.org/10.5551/jat.64024
For more information on our sdLDL-C assay or any of our other products, please contact us at: marketing@randox.com
World Health Day 2023
Randox is celebrating WORLD HEALTH DAY!
We are dedicated to improving healthcare using innovative diagnostic technologies, for a range of health conditions including heart disease, diabetes, Alzheimer’s disease, cancer, and stroke.
Whilst the science is complex, the applications are not. Diagnostic testing takes place every day behind the scenes of GP surgeries, laboratories, and hospitals.
To celebrate and raise awareness of the health industry, we have written the article below which focuses on the challenges in cancer screening, diagnosis, improving risk stratification, and patient management.
Give it a read and let us know your thoughts!
Overcoming the challenges in cancer screening, diagnosis, improving risk stratification & patient management
The problem
Cancer diagnosis is an art, in many cases requiring complex equipment and time-consuming protocols to achieve only relatively specific and sensitive tests. There are several approaches used to screen for and diagnose different forms of cancer including the identification of biomarkers, quantification of metabolic analytes and genomic sequencing, each displaying their own advantages and limitations.
The identification and quantification of analytes is an effective screening method for some cancers. The Glasgow Prognostic Score (GPS) utilises serum CRP and albumin quantification to provide invaluable prognostic information for pancreatic, colorectal, hepatocellular and other forms of malignant tumours1. While this, and other similar methods can provide reliable, prognostic data they are rarely considered diagnostic. Furthermore, tests such as these often require multiple samples or large sample volumes, repeated hospital visits, and manually dominated test protocols, increasing the risk of human error.
Next generation sequencing (NGS) is an innovative form of genomic sequencing used in cancer diagnosis to identify genes, parts of genes, and genetic mutations known to be related to either cancer in general, or specific forms of cancer. Whilst accurate, NGS screening requires expensive, complex equipment and prolonged protocols, somewhat limiting their utility in providing patients with a timely diagnosis.
Finally, a variety of imaging techniques can be used to visualise tumour growth in the body. These methods are well established, however, are normally not independently diagnostic and can only detect large groups of cancer cells, or tumours, which are evident only in the later, more fatal stages of cancer.
Due to limited resources and other contributing factors, an estimated 1 million cancer diagnosis have been missed in Europe since the beginning of the COVID-19 pandemic2, providing evidence for the need for fast, simple, and accurate screening and diagnostic techniques.
The solution
In 2002, Randox invested £180 million to develop the patented Biochip Array Technology (BAT) in response to the known limitations in diagnostics. This ground-breaking assay technology utilises multiplex testing methodology to provide a rapid, accurate and user-friendly methods for the diagnosis and screening of a wide variety of biomarkers. For use in molecular and protein-based immunoassays, BAT works by combining a panel of related biomarkers in a single biochip with one set of reagents, controls, and calibrators. Unlike other forms of testing which require a sample for each individual test, BAT can provide simultaneous qualitative and quantitative detection of a wide range of biomarkers from a single sample.
The biochip detection system is based on a chemiluminescent reaction. This is the emission of light, without heat, as a result of a chemical reaction. An enzyme is used to catalyse the chemical reaction on the biochip which generates the chemiluminescent signal. The light emitted from the chemiluminescent reaction that takes place in each Discrete Test Regions (DTR) is simultaneously detected and quantified using a Charge-Coupled Device (CCD) Camera.
Each biochip has up to 49 Discrete Test Regions meaning up to 44 tests can be carried out simultaneously. The additional DTRs are reserved for internal quality control and visual reference, a unique Biochip Array Technology feature.
Advantages of Biochip Array Technology
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Reduced times spent on individual tests as a result of multiplex testing, helping reduce required time and expense .
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The vast biochip test menu allows clinicians to detect routine and novel markers for advanced diagnostic analysis.
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Multiple sample types can be used on a single analyser including serum, plasma, whole blood, urine, oral fluid and alternative matrices.
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Testing for multiple markers helps to simultaneously increase the amount of returned patient information allowing for more informed patient diagnosis.
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BAT has a proven high standard of accurate test results with CV’s of less than 10%.
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Barcoded biochips and patient samples ensure complete traceability of results.
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Biochips are manufactured free from Biotin-streptavidin to reduce cross-reactivity.
Randox BAT has been used to develop several arrays for the detection of routine and novel biomarkers related to various forms of cancer, allowing for improved risk stratification and improve patient management reducing current invasive diagnosis methods.
Randox Pancreatic GlycoMarker Array
Pancreatic cancer is an aggressive form of cancer, one associated with very poor prognosis, often not diagnosed until it has reached the late stages. The 5-year survival rate of 9% attributed to pancreatic cancer indicates a requirement for fast, effective screening and diagnosis. The only FDA approved biomarker for use in pancreatic cancer diagnosis is CA 19-9. However, this biomarker has been shown to display inadequate sensitivity and high levels of false results when used independently and is known to be indicative of various forms of cancer1.
To this end, Randox has developed the Pancreatic GlycoMarker Array, which utilises three distinct biomarkers in a glycosylation-based multiplex detection system. The simultaneous detection of CA 19-9, Carcinoembryonic antigen (CEA) and Alpha-1-Acid Glycoprotein (A1AG) from a single patient sample provides increased sensitivity and specificity for pancreatic cancer when compared with traditional CA 19-9 analysis alone1. Capable of providing results in under 2 hours, this array provides impressive test turnaround times enabling effective intervention and treatment.
| Biomarker | Description |
| CA 19-9 | Cancer antigen 19-9 is a sialyl-Lewis A tetrasaccharide which around 10% of the population cannot express. It is associated with various forms of cancer most importantly, pancreatic, colorectal, and hepatic cancers. Levels of CA 19-9 are also known to be elevated in non-malignant diseases such as chronic pancreatitis1. |
| CEA | Carcinoembryonic antigen is a widely utilised biomarker for different tumours. In pancreatic cancer, increased CEA levels were shown to be evident in 60% of patients3 |
| A1AG | Alpha-1-Acid Glycoprotein is primarily produced by the liver; however, expression has been shown by various cancer cells. Altered glycosylation of A1AG is indicative of malignancy and metastasis4. |
The table below has been taken from an analysis carried out by Randox to determine the Area under curve (AUC), sensitivity, and specificity of these biomarkers, both as a full panel, and individually:
Table 1. Results of an investigation to determine the Area under curve (AUC), sensitivity and specificity of Randox GlycoMarker Array targets both individually and as a panel.
Colorectal Cancer
KRAS, BRAF, PIK3CA Array
Colorectal cancers (CRCs) are the third most common form of cancer, accounting for an estimated 1.93 million cases in 20205. There are three major genes which, when mutations occur, are associated with CRC: KRAS, BRAF and PIK3CA.
Kirsten rat sarcoma (KRAS) is an oncogene frequently mutated in CRC. Around 40% of CRC patients display missense mutations in KRAS most of which occur in codons 12, 13 and 616. The protein encoded by this gene acts as a molecular switch, alternating between a GDP-bound inactive state and a GTP-bound active state. The binding of GTP to the KRAS protein is key in the binding of effectors and the initiation of several downstream pathways which promote cell growth and proliferation. Mutations in the KRAS gene will result in a disruption in hydrolysis of GTP and/or an increase in nucleotide exchange, resulting in an accumulation of the KRAS protein in its active state, the subsequent, continuous activation of downstream signalling pathways and ultimately the proliferation of cancer cells6. Approximately 85% of KRAS mutations occur in codons 12, 13, and 61, with codon 12 being host to 65% of these. Mutations in these codons are associated with extremely poor prognosis compared with wild-type (WT) KRAS cases6.
Mutations in the BRAF gene are evident in an average of 12% of CRC patients, the majority of which are attributed to a BRAF V600E (valine 600 to glutamate) substitution7. CRC patients which display this mutation have a median overall survival (OS) of 11 months and are associated with high levels of epigenetic expression through DNA methylation when compared with WT BRAF patients. V600E mutations are known to inhibit the expression of caudal-type homeobox 2 (CDX2), a tumour suppressor and transcriptional factor crucial in the regulation of intestinal epithelial cell differentiation, cell adhesion, and polarity. The loss of CDX2 activity is associated with high levels of metastasis and poor prognosis in CRC patients7.
PIK3CA mutations are common in various forms of cancer, promoting carcinogenesis through the dysregulation of important cancer signalling pathways. PIK3CA encodes the alpha catalytic subunit of PIK3 (phosphatidylinositol-4,5-bisphosphate 3-kinase), which is responsible for the phosphorylation of phosphatidylinositol-4,5-bisphosphate to phosphatidylinositol-4,5-triphosphate. This newly phosphorylated molecule simultaneously binds kinase PDK1, mTORC2 and serine/threonine kinase, AKT. The phosphorylation of AKT results in the downstream activation of pro-carcinogenic factors and inhibition of tumour suppressor activity, including inhibition of the transcription factor, FOXO1. FOXO1 has several important functions relating to cell apoptosis and proliferation and acts as a context-dependant tumour suppressor8.
The Randox KRAS, BRAF, PIK3CA Array is based on a combination of multiplex PCR and biochip array hybridization for high discrimination between multiple wild‑type and mutant DNA regions in the KRAS, BRAF, and PIK3CA genes. Providing there are enough copies of DNA present, approximately 1% of mutants can be readily detected in a background of wild‑type genomic DNA. A unique primer set is designed for each mutation target and control, which will hybridize to a complementary DTR on the biochip array. Each DTR corresponds to a particular mutation target. With the ability to simultaneously detect 20 mutation points within the KRAS, BRAF and PIK3CA genes, this array can aid clinicians in diagnosis and screening of CRC and help provide insightful information regarding treatment options and prognosis.
Female Bladder Cancer Array
Bladder cancer is considered the most significant cause of haematuria. Bladder cancer is very common, estimated to be the 6th most common in men and 17th most common form of cancer in women9. However, this disparity means bladder cancer in women is often overlooked and the associated haematuria is often attributed to other diagnosis. Those who are correctly diagnosed often experience delayed diagnosis and treatment resulting in worse survival probability10. Cystoscopy, an invasive endoscopy procedure of the urethra and bladder, is the gold standard for the diagnosis. This procedure carries high risk of infection, bleeding and is extremely uncomfortable for the patient. Furthermore, bladder cancer is associated with a high recurrence rate, meaning patients require monitoring for the remainder of their lives, displaying the urgent need for less invasive, fast, effective, and gender-specific screening methods for bladder cancer detection.
The urgent need for evidence-based risk stratification models for screening, diagnosis and subsequent management of patients presenting with haematuria prompted Randox to develop the Female Bladder Cancer Array. Utilising a combination of biomarkers known to provide high sensitivity and specificity, this array is designed to assist clinicians to differentiate patients presenting with haematuria from those with other causes, while removing the need for invasive imaging techniques. This array detects IL-12p70, IL-13, Midkine and Clusterin to provide a comprehensive panel of targets aiding clinicians in risk-stratification, diagnosis, and ongoing monitoring of female bladder cancer patients.
Biomarker |
Description |
IL-12p70 |
Interleukin 12p70 is a disulphide linked heterodimeric cytokine which regulates inflammation by linking innate and adaptive immune responses and potent inducer of antitumor immunity. |
IL-13 |
Interleukin-13 is an immunoregulatory cytokine which plays an important role in carcinogenesis through affecting tumour immunosurveillance. IL-13 in the bladder cancer patients suggests that this cytokine is involved in progression in bladder cancer patients. |
Midkine |
Midkine is a member of a family of heparin-binding growth factors, which has been reported to have an important role in angiogenesis and is associated with bladder cancer progression. |
Clusterin |
Clusterin is conserved glycoprotein that has been distinguished from human fluids and tissues which plays a key role in cellular stress response and survival. It is evident in cancer metastasis, which is particularly important to design the strategies for treating metastatic patients. |
The Evidence Investigator
The Evidence Investigator is a compact semi-automated benchtop analyser. It is a perfect fit for medium throughput laboratories seeking maximum use of bench space without compromising on the volume of samples processed.
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Estimated turnaround time: Less than 5 hours
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Detection from nucleic acid
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Batch testing
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Suitable for laboratory setting
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Comprehensive test menu
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Medium to high throughput – 54 samples and reporting 540 results in less than 5 hours
For references related to this article- References
For more information on this, please contact us at: market@randox.com
MRSA – Emerging Therapeutic & Screening Approaches
Staphylococcus aureus is a gram positive, commensal bacteria found in normal human flora on the skin and mucous membranes. The commensal nature of this organism results in colonisation of around half of the general population, rising to around 80% in populations of healthcare workers, hospitalised patients and the immunocompromised1. However, given the opportunity to colonise internal tissues or the bloodstream, S. aureus infection can cause serious disease. Skin conditions caused by S. aureus include impetigo, scalded skin syndrome, boils, and abscesses. Examples of more serious conditions include meningitis, pneumonia, endocarditis, bacteraemia, and sepsis2.
Antimicrobial resistance (AMR) has, and continues to be, one of the largest threats to global health. In 2019, it is estimated that 1.27 million deaths globally were directly attributed to AMR, based on the drug-susceptible counterfactual, with only ischaemic heart disease and stroke accounting for more deaths in that year1. Figure 1 shows a global distribution map of MRSA isolates from the data of this comprehensive study. Methicillin-resistant Staphylococcus aureus (MRSA) was first identified only one year after the introduction of the penicillin-like antibiotic, methicillin3. While methicillin is no longer used in clinical practice, the term MRSA is used to encompass resistance to commercially available antibiotics such as β-lactams3. For many years, much work has gone into seeking novel therapies to combat drug-resistant bacteria, however, the indiscriminate overuse of antibiotics seen around the world, along with other factors, continues to contribute to the rise in AMR.
Identification of drug-resistant strains of bacteria is crucial to allow for characterisation of the pathogen and correct treatment of the infection. Classical evaluation consists of a routine culture to verify a diagnosis based on presenting symptoms. However, this can be a time consuming and laborious process which may delay diagnosis and treatment of a potentially fatal infection1.
Methicillin-Resistant Staphylococcus aureus
Methicillin is of a class of antibiotics known as β-lactams which bind to the penicillin binding protein (PBP) of the bacteria. PBP is responsible for crosslinking between N-acetylmuramic acid and N-acetylglucosamine which forms the architecture of the bacterial cell wall. When β-lactams bind to the PBP, a build-up of peptidoglycan precursors triggers autolytic digestion of peptidoglycan, facilitated by hydrolase. This reduction in peptidoglycans results in the loss of the integrity of the bacterial cell wall and ultimately culminates in cell damage caused by high internal osmotic pressure.
While methicillin has lost its clinical utility due to the emergent resistance, MRSA is used to describe S. aureus which displays resistance to penicillin-like antibiotics such as amoxicillin and oxacillin, as well as other forms of commercially available antibiotics like macrolides, tetracyclines, and fluroquinolones4. A meta-analysis by Dadashi et al., showed that 43% of S. aureus isolates where methicillin-resistant, exhibiting the prevalence of MRSA5.
Transmission is possible from direct contact with an infected individual or through contact with fomites2. MRSA infections can be categorised as either community acquired infections (CA-MRSA), or hospital acquired infections (HA-MRSA). While rates of HA-MRSA have fallen over the last ten years, this decrease in infection rates has not translated to CA-MRSA6. This is evidence of the requirement for quicker, easier testing in community settings to identify those infected by MRSA and to trigger the initiation of isolation and treatment.
While the pathophysiology of MRSA will largely depend on the causative strain of bacteria, collectively, S. aureus is the most common bacterial infection in humans and may result in infections of varying severity including1:
- Bacteraemia
- Infective endocarditis
- Skin and soft tissue infections
- Osteomyelitis
- Septic arthritis
- Prosthetic device infections
- Pulmonary infections
- Gastroenteritis
- Meningitis
- Toxic shock syndrome
- UTIs
Development of resistance and resistance mechanisms
Antimicrobial resistance arises from a combination of mechanisms. Genetic mutations are crucial in the development of resistance mechanisms. These genetic mutations must favour the survival of the mutated gene and the advantage of AMR mechanisms to the survival of bacteria cannot be understated. Regarding MRSA, S. aureus can gain resistance through horizontal gene transfer mediated by plasmids, mutations in chromosomal genes or mobile genetic elements4. Methicillin-susceptible Staphylococcus aureus (MSSA) gains the staphylococcal cassette chromosome (SCCmec) gene, a gene containing mecA, which is responsible for some of the resistance mechanisms displayed by MRSA4. The collection of antibiotics the bacteria gains resistance to, will depend on the SCCmec gene type.
The first mechanism of resistance is the expression of β-lactamase which functions to degrade β-lactams, ultimately resulting in loss of function of the antibiotic. This enzyme hydrolyses β-lactam ions in the periplasmic space, denaturing the antibiotic before it can interact with bacteria3. The mecA gene encodes the protein penicillin-binding protein 2a (PBP-2a), a type of PBP which has lower affinity for β-lactams, as well as other penicillin-like antibiotics due its conformation, meaning that the presence of these antimicrobial agents does not confer a loss of structure in the bacterial cell wall1.
One study conducted by Hosseini et al., investigated resistance mechanisms in MRSA and showed that all multidrug resistance MRSA strains displayed biofilm formation as part of its resistance strategy7. Biofilms induce resistance to high concentrations and a large variety of antimicrobial agents and help regulate anti-bacterial immune responses. Biofilm formation is mediated by the protein, polysaccharide intercellular adhesin (PIA). Furthermore, MRSA strains which display biofilm formation are associated with more severe and more virulent infections7.
Current and Emerging Therapeutic Strategies
Other types of antibiotics have been used to treat MRSA infections over the years. Vancomycin has been used to combat infections resistant to penicillin-like antibiotics as they display a different mode of action. Vancomycin inhibits peptidoglycan synthesis by forming hydrogen bonds within the structure of peptidoglycan precursors2. While this strategy has proven effective for past 50 years, more and more strains are displaying vancomycin resistance in addition to resistance to penicillin-like antibiotics8. One study by Deyno et al., estimates the prevalence of vancomycin-resistant S. aureus in Ethiopia to be around 11% 4. Daptomycin is another antibiotic which has been shown to be effective in MRSA treatment. This cyclic lipopeptide binds to the bacterial membrane, resulting in cell death9.
Due to the decreasing number of available, effective antibiotics, novel therapeutic strategies are required to combat MRSA infection. One of the most promising approaches uses antimicrobial peptides (AMPs). AMPs are naturally occurring molecules of the innate immune system and have one of two mechanisms of action: membranolytic action and non-membranolytic action. AMPs normally consist of and amphipathic or cationic structure, between 5-50 amino acids long. Naturally occurring AMPs have been used as a model to develop synthetic AMPs, designed to neutralise the limitations of natural AMPs boasting an improved half-life and improved antimicrobial properties3. Membrane disruptive AMPs can be further categorised by mechanism of action. The first is the Toroidal-pore model in which AMPs form vertical pores in the bacterial membrane causing a change in conformation of the lipid head. Next is the Barrel-stave mode, in which AMPs bind to the bacterial membrane and aggregate before breaching the cell wall causing uncontrolled cell movement, resulting in cell death3. Finally, in the carpet model, the membrane is destroyed in a detergent-like action where the AMPS arrange on the cell membrane with their hydrophobic part facing the phospholipid bilayer, altering the surface tension of the membrane. This eventually results in the formation of micelles and the destruction of the bacterial membrane3.
Non-membrane disruptive AMPs require much more investigation; however, it is accepted that these AMPs enter the cell, reacting with important intracellular components inhibiting protein and nucleic acid synthesis, cell division and protease activity3.
Silver nanoparticles (AgNPs) exhibit broad spectrum antimicrobial properties through various mechanisms of action. These nanosized particles boast increased antimicrobial properties due to an increased surface area per volume ratio. The first mechanism of action to note is AgNPs direct adhesion to the bacterial membrane, which alters the structural integrity of the membrane, allowing the AgNPs to penetrate the cell, wreaking havoc on the intracellular components until it loses the ability to carry out essential cellular processes3.
Once the AgNPs aggregate on the bacterial surface, the difference in electrostatic charge, driven by the positive charge displayed by the AgNPs and negatively charged bacteria, pit formation occurs on the cell surface, inhibiting vital cellular movement, resulting in cell death3. AgNPs may also inhibit protein synthesis by denaturing ribosomes and directly interacting with DNA. This interaction can cause denaturing of the DNA helix and ultimately result in cell death3. Finally, AgNPs can induce the production of reactive oxygen species (ROS) and free radicals. The molecules cause irreversible cell damage to the bacteria3.
While AMPs and AgNPs each possess individual limitations such as toxicity and instability, studies show that a combination of these therapeutic strategies can overcome these issues, stabilising the antimicrobial agents to their respective target sites3.
Screening, Testing & Evaluation
Classical determination of MRSA and other bacterial infections consists of obtaining a patient sample and growing colonies from the patient sample in culture. These cultures can then be investigated under a microscope and characterised, allowing diagnosis and the initiation of treatment. Whilst effective, these methods are time consuming and laborious, taking up to three days for cultures to develop, somewhat limiting their utility for the diagnosis of potentially fatal infections.
New molecular rapid PCR microbiology techniques aid in the identification of bacterial strains through a three-step process involving extraction, amplification, and detection. These new methods allow for timely identification of infectious strains and AMR characterisation. Specific genes or sections of gene which are responsible for AMR can be detected, helping to achieve strain characterisation and aid physicians in prescribing the correct treatment plan. These methods improve test turnaround times to around one to two days and help to reduce the risk of costly human error and contamination.
Vivalytic MRSA/SA
Bosch Vivalytic MRSA/SA is an automated qualitative in vitro diagnostic test based on real-time PCR for the detection and differentiation of methicillin-resistant Staphylococcus aureus (MRSA) and Methicillin-sensitive Staphylococcus aureus (MSSA) DNA from human nasal- or oropharyngeal swabs to aid in the diagnosis of MRSA infection of symptomatic or asymptomatic individuals, providing results in less than 1 hour.
Without MRSA screening, many MRSA colonised patients remain unnoticed in hospitals and will not be isolated. Without Isolation many of these patients transfer the pathogen to at least one other patient during their hospital admission. PCR based screening is associated with high precision and fast time to results and is often used for early decisions on isolation and hygiene measures.
This POCT system provides fast, accurate characterisation of MRSA/SA strains while minimising the required user steps and reducing the need for expensive laboratory equipment helping physicians implement timely and effective treatments.
Detectable Pathogens:
- Methicillin-resistant Staphylococcus aureus
- Methicillin-sensitive Staphylococcus aureus
Specific Gene Targets:
- SCCmec/orfX junction
- MecA/MecC
- SA422
Some of the other benefits of this test include:
- Multiple sample types – Data shows that for approx. 13% of MRSA carriers, the pathogen is only located in the throat. Therefore, using throat swabs significantly increases the sensitivity of detection by approx. 26%.
- Broad MRSA Range – mecA or mecC are the genes responsible for resistance to β-lactam antibiotics. mecA/meC is part of the mobile genetic element Staphylococcal cassette chromosome mec (SCCmec). Vivalytic MRSA/SA can detect mecA as well as mecC and a broad variety of SCCmec elements which help to reduce false negative results.
- Fast time-to-result – Provides quick results in less than 1hr allowing quick decisions on therapies. Traditional culture time-to-result is 48-72hrs and laboratory PCR is 12-24hrs.
- This highly automated system minimises the user steps required to achieve a result while limiting the requirement for expensive lab equipment and sample transportation. Vivalytic MRSA/SA POCT test allow the implementation of treatment as soon as 1hr after sample collection.
References
- Murray CJ, Ikuta KS, Sharara F, et al. Global Burden of Bacterial Antimicrobial Resistance in 2019: A Systematic Analysis. The Lancet. 2022;399(10325):629-655. doi:https://doi.org/10.1016/S0140-6736(21)02724-0
- Nandhini P, Kumar P, Mickymaray S, Alothaim AS, Somasundaram J, Rajan M. Recent Developments in Methicillin-Resistant Staphylococcus aureus (MRSA) Treatment: A Review. Antibiotics. 2022;11(5):606. doi:https://doi.org/10.3390/antibiotics11050606
- Masimen MAA, Harun NA, Maulidiani M, Ismail WIW. Overcoming Methicillin-Resistance Staphylococcus aureus (MRSA) Using Antimicrobial Peptides-Silver Nanoparticles. Antibiotics. 2022;11(7):951. doi:https://doi.org/10.3390/antibiotics11070951
- Liu WT, Chen EZ, Yang L, et al. Emerging resistance mechanisms for 4 types of common anti-MRSA antibiotics in Staphylococcus aureus: A comprehensive review. Microbial Pathogenesis. 2021;156:104915. doi:https://doi.org/10.1016/j.micpath.2021.104915
- Dadashi M, Nasiri MJ, Fallah F, et al. Methicillin-resistant Staphylococcus aureus (MRSA) in Iran: A systematic review and meta-analysis. Journal of Global Antimicrobial Resistance. 2018;12:96-103. doi:https://doi.org/10.1016/j.jgar.2017.09.006
- Kourtis AP, Hatfield K, Baggs J, et al. Vital Signs: Epidemiology and Recent Trends in Methicillin-Resistant and in Methicillin-Susceptible Staphylococcus aureus Bloodstream Infections — United States. MMWR Morbidity and Mortality Weekly Report. 2019;68(9):214-219. doi:https://doi.org/10.15585/mmwr.mm6809e1
- Hosseini M, Shapouri Moghaddam A, Derakhshan S, et al. Correlation Between Biofilm Formation and Antibiotic Resistance in MRSA and MSSA Isolated from Clinical Samples in Iran: A Systematic Review and Meta-Analysis. Microbial Drug Resistance. Published online March 10, 2020. doi:https://doi.org/10.1089/mdr.2020.0001
- Verma R, Verma SK, Rakesh KP, et al. Pyrazole-based analogs as potential antibacterial agents against methicillin-resistance staphylococcus aureus (MRSA) and its SAR elucidation. European Journal of Medicinal Chemistry. 2021;212:113134. doi:https://doi.org/10.1016/j.ejmech.2020.113134
- Deyno S, Fekadu S, Astatkie A. Resistance of Staphylococcus aureus to antimicrobial agents in Ethiopia: a meta-analysis. Antimicrobial Resistance & Infection Control. 2017;6(1). doi:https://doi.org/10.1186/s13756-017-0243-7
Lipoprotein (a) Awareness Day 2023
Randox are raising awareness for Lipoprotein(a), we want to drive awareness on tests that are available to you to decrease the risk of stroke, heart attack or other heart diseases!
Lp(a) is a risk factor for atherosclerosis and related diseases including CHD and stroke. It is increasingly recognised as the strongest known genetic risk factor for premature coronary artery disease.
Identifying any possible health conditions that would relate to early signs of stroke, heart attack or other heart diseases will allow you to make any decisions on an appropriate diet, lifestyle changes and early treatment to reduce your risk of further problems.
Benefits of the Randox Lp(a) assay
WHO/IFCC Reference Material
WHO/IFCC Reference Material
Dedicated Five-Point Calibrator Available
Dedicated Five-Point Calibrator Available
Excellent Correlation
Excellent Correlation
Excellent Precision
Excellent Precision
Liquid Ready-To-Use
Liquid Ready-To-Use
Available in nmol/L
Available in nmol/L
Applications Available-on Roche, Abbott, Beckman, and more.
Applications Available-
The biggest challenge that exists surrounding Lp(a) measurement is the heterogeneity of the apo(a) isoforms, resulting in the underestimation or overestimation of Lp(a) concentrations. In immunoassays, the variable numbers of repeated KIV-2 units in Lp(a) act as multiple epitopes. This is where standardisation across calibrators is vital. Unless the calibrants do have the same range of isoforms as test samples, those with higher numbers of the KIV-2 repeat, will represent with an overestimation in Lp(a) concentrations and those with smaller numbers of the KIV-2 repeat, will represent with an underestimation. The smaller isoforms are strongly associated with higher Lp(a) concentrations. Lack of standardisation of the calibrant would result in an underestimation of Lp(a) associated CVD risk. It is important to note that an Lp(a) immunoassay employing isoform insensitive antibodies does not exist.
How can Randox help?
Randox Sales Reps are experts in their fields and are available to discuss your specific requirements.
Simply send us an email by clicking the link below and we will get in touch!
THE 2023 RANDOX GRAND NATIONAL TROPHY IS REVEALED
THE 2023 RANDOX GRAND NATIONAL TROPHY IS REVEALED
Sunday 19th March
Elizabeth Moran of Randox, who designed the trophy, said: “It was a wonderfully creative challenge to design this year’s trophy, reflecting both this national, iconic sporting event and Randox’s innovation within healthcare, and I think we got it just right.”
During the Randox Grand National Festival (Thursday 13th April – Friday 15th April inclusive), the trophy as well as trophies from previous Randox Grand Nationals, can be viewed in trophy marquee next to the Red Rum Garden at Aintree Racecourse.
World Kidney Day 2023
World Kidney Day 2023
“Kidney health for all – Preparing for the unexpected, supporting the vulnerable”
Thursday 09th March
Chronic Kidney Disease (CKD) is considered a leading cause of global mortality with an overall global prevalence rate of around 13%1. This figure rises to 15% in the US2 and the statistics show that these rates are likely to continue this upward trend3. CKD is defined as damage to the kidneys which affects its ability to correctly filter bodily fluids which ultimately results in renal replacement therapy in the form of dialysis or transplantation4. This sustained or chronic damage of the kidney encourages kidney fibrosis and loss of structure. The early stages of CKD are generally asymptomatic with symptoms beginning to manifest in stages 4 and 5. These symptoms include nausea & vomiting, fatigue & weakness, oliguria, chest pain, hypertension, to name a few4.
World Kidney Day is an annual, global campaign spearheaded by the International Society of Nephrology (ISN) and the International Federation of Kidney Foundations – World Kidney Alliance (IFKF – WKA) which intends to raise awareness of how critical our kidneys are and to limit the prevalence and impact of kidney disease5. This year’s focus is “Kidney health for all – preparing for the unexpected, supporting the vulnerable.”
It is no surprise that patients suffering from noncommunicable diseases (NCDs) such as CKD were subject to worse prognosis during the COVID-19 pandemic6 due to prioritising of ongoing complex care over acute patient care7. But a pandemic is only one circumstance, albeit a major one, which can affect the ability of hospitals and laboratories to uphold their normal testing capacity. For example, natural disasters can make it impossible for people to reach facilities for testing or treatment7. Similar situations could arise at a more local level such as road closures, power outages or public transport strikes which have the potential to delay diagnosis or treatment.
To this end, laboratories should look to introduce novel and effective methods for testing under adverse conditions. Rapid testing will be imperative to help achieve these goals and promote fast test turnaround times and accurate diagnosis. The Randox CKD Arrays, in conjunction with the Randox Evidence Investigator, allow for simultaneous and quantitative detection of multiple serum biomarkers of kidney damage-related analytes allowing diagnosis at a much earlier stage than traditional creatinine tests.
Utilising patented Biochip Technology, the Randox CKD arrays could improve patient risk stratification whilst monitoring the effectiveness of treatment. Diagnosis of CKD at early stages will allow earlier intervention for the treatment of kidney disease, and the prevention of further kidney damage. The utility of this test cannot be overstated. In adverse circumstances, the Randox Evidence Investigator could permit diagnosis of CKD and determination of CKD severity at the site of the patient, helping prepare for the unexpected and support the vulnerable.
More information of CKD and other kidney related conditions can be found at: Homepage – World Kidney Day
References
Bibliography
-
Lv JC, Zhang LX. Prevalence and Disease Burden of Chronic Kidney Disease. Advances in Experimental Medicine and Biology. 2019;1165:3-15. doi:https://doi.org/10.1007/978-981-13-8871-2_1
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Centers for Disease Control and Prevention. Chronic Kidney Disease in the United States, 2021. US Department of Health and Human Services; 2021. https://www.cdc.gov/kidneydisease/pdf/Chronic-Kidney-Disease-in-the-US-2021-h.pdf
-
Kovesdy CP. Epidemiology of chronic kidney disease: an update 2022. Kidney International Supplements. 2022;12(1):7-11. doi:https://doi.org/10.1016/j.kisu.2021.11.003
-
Vaidya SR, Aeddula NR. Chronic renal failure. Nih.gov. Published 2019. https://www.ncbi.nlm.nih.gov/books/NBK535404/
-
International Society of Nephrology. Homepage. World Kidney Day. Published 2023. https://www.worldkidneyday.org/
-
Nikoloski Z, Alqunaibet AM, Alfawaz RA, et al. Covid-19 and non-communicable diseases: evidence from a systematic literature review. BMC Public Health. 2021;21(1). doi:https://doi.org/10.1186/s12889-021-11116-w
-
Hsiao LL, Shah KM, Liew A, et al. Kidney health for all: preparedness for the unexpected in supporting the vulnerable. Kidney International. 2023;103(3):436-443. doi:https://doi.org/10.1016/j.kint.2022.12.013
For more information, please contact Market@randox.com
Diagnosing UTI Complications in Mothers and Newborns
Diagnosing UTI Complications in Mothers and Newborns
Urinary tract infections (UTIs) are one of the most common bacterial infections that occur in humans. Over 50% of women become infected with a UTI at least once in their lives, with up to 10% of women suffering from yearly infections5. Recurrence rates are high in UTIs, almost 50% of women who contract a UTI experience reinfection or relapse within one year of the initial infection5. Men are four times less likely to contract a UTI due to a longer urethra seen in men when compared with women.
Infections occur in the urinary organs and structures which can be categorized by the site of infection: cystitis (bladder), pyelonephritis (kidney) and bacteriuria (urine)5. So-called, uncomplicated UTIs are sited only in the bladder, however, UTIs are highly likely to cause secondary infections, commonly in the kidneys. Pyelonephritis has been shown to result in renal scarring and in some cases, subsequent renal failure2. There are various species of bacteria responsible for UTIs, which have different mechanisms of infection and virulence. However, most species have surface adhesins which function like hooks, attaching the bacteria to the urothelial mucosal surface, and colonizing the bladder. From here, the bacteria can ascend the ureters, reaching the kidney and causing secondary infections2.
Under normal conditions, the innate immune system actions an inflammatory response to the infection site. However, some species of bacteria that cause UTI can inhibit or delay the immune response resulting in secondary infections in the ureters and kidneys where the risk of severe renal defects is considerable, and the bacteria have direct access to the bloodstream2.
Common symptoms of UTI include:
- Frequent urination
- Painful urination
- Incomplete voiding of the bladder
- Pelvic, back, and/or abdominal pain
- Haematuria
- Lethargy
- Nausea and/or vomiting
- Fever
Antibiotic therapies are effective and aim to facilitate the immune response and inhibit the spread of the infection to the kidneys and upper urinary tract. Although these treatments are usually effective, antimicrobial resistance (AMR) has become a global crisis encompassing all medical disciplines3. This resistance to antibiotics can occur through several mechanisms such as dysregulation of protein expression, structural modifications, and mutations to name a few11.
Bacteria are capable of some level of intrinsic resistance, or insensitivity, to antibiotics through the production of various enzymes designed to degrade the drug or inhibit its mechanism11. Mutations found in the genome of bacterial species are often responsible for the resistance they display. These mutations commonly alter the bacterial binding sites used by antibiotics, therefore inhibiting their action. Some bacteria produce enzymes, which alter the chemical structure of the antibiotic, again, inhibiting them from binding to the antibiotic. Other examples include horizontal gene transfer and biofilm formation10.
One study reported in 2019, that AMR was the twelfth leading cause of death when compared with a susceptible infection counterfactual9. The same study went on to show that AMR had the highest mortality rate in low to middle-income countries providing evidence that AMR is an even bigger problem in the most impoverished parts of the world. New techniques such as CRISPR-Cas9 and antibiotic re-sensitization methods are at the forefront of the fight against AMR, however, the scale of the problem warrants taking all possible action to elevate the risk posed by AMR8.
UTI During Pregnancy
UTIs are a common occurrence in pregnancy with one hospital reporting over 15% of pregnant women being diagnosed with some form of UTI4. Diagnosis can usually be confirmed by a bacterial growth of over 105 counts/ml in urine4, 12, 13. Many hormonal and anatomical changes occur in a woman’s body during pregnancy that create favorable conditions for UTI. Firstly, the glomerular filtration rate is altered, causing an increase in glucose concentration and pH of the urine3. The urethral dilation, smooth muscle relaxation, enlarged mechanical compression of the uterus, and increased plasma volume result in lower urinary concentration and increased bladder size leading to urinary tract reflux and urine stagnation. These conditions are favorable for the proliferation of bacterial infections1.
Diagnosis of UTIs in pregnant women can be complicated. For example, the increased frequency of urination experienced could also be caused by additional pressure placed on the woman’s bladder by the baby, or the abdominal pain indicative of a UTI could be interpreted as Braxton Hicks contractions and vice versa3. There are several established risk factors associated with UTI in pregnancy including advanced maternal age, diabetes, sickle cell anemia, history of UTI, urinary tract abnormalities, and various immunodeficiencies3. Other reports claim that UTI in pregnancy is more common in women with hypothyroidism and women who are carrying their first child4.
Bacterial Species Responsible for UTI
There are a multitude of bacterial species responsible for UTIs, the most common is Escherichia coli (E. coli), followed by group B streptococcus (GBS), enterococcus, and Klebsiella pneumonia. Escherichia coli infections are categorized as either enteric or extraintestinal (ExPEC). Of the latter, there are two main culprits: neonatal meningitis E. coli (NMEC) and uropathogenic E. coli (UPEC)2. These infections can exist in the gut and spread, colonizing other parts of the host such as the blood or central nervous system, causing other potentially severe infections. Of these strains, UPEC is responsible for around 80% of both symptomatic and asymptomatic UTIs. UPEC strains have been associated with acute renal damage and are thought to encourage bacterial growth and persistence by inhibiting or delaying the innate immune response2.
Maternal and Perinatal UTI Complications
UTI complications in mothers and children have long been debated. However, there is sufficient evidence to support several prognostic claims. Preterm delivery is a major complication associated with UTI and has been well studied. Preterm neonates face a high risk of fatality with up to 1 million babies dying every year due to premature labor6. Those that survive are at risk of developing one or more of the following health defects1:
- Lung problems
- Diabetes
- Heart Disease
- Hearing loss
- Visual impairment
- Learning disabilities
- Behavioral problems
- Cerebral palsy
The risk of preterm birth in women who suffered from a single UTI was increased when compared to women who had no infection during their pregnancy but recurrent UTIs did not increase the risk3. Risk of low birth weight has been shown to increase by 50% in women who suffered symptomatic UTIs compared to those who remained uninfected throughout their pregnancy; this risk can be mitigated through antibiotic therapy. The same treatments did not show any significant ameliorative effects on preterm birth4. Women who contract a UTI during pregnancy are also at a higher risk of various conditions such as preeclampsia, postpartum endometritis, sepsis1, hypertensive disorders, anemia and amnionitis4.
Asymptomatic UTIs, also known as asymptomatic bacteriuria (ASB), are not known to cause as drastic primary effects on pregnancy as seen with symptomatic infections. Despite this, ASB can spread and colonize in the kidneys. At this point, pyelonephritis is likely to occur, increasing the risk of severe renal scarring4 and advanced risk of preterm birth3. In these cases, it is common to treat the patient with antibiotics to reduce the risk of a secondary, symptomatic infection. While these treatments are effective at limiting the progression of the infection, overuse of antibiotics is a primary factor contributing to antimicrobial resistance4.
Screening and Treating UTI Complications
Women who are not pregnant and show no risk factors can be tested for UTI through a simple urine dipstick. The presence of leukocyte and absence of nitrite can be considered a positive UTI diagnosis. However, where complications are likely, a urine culture is required. Cultures can be carried out on blood or MacConkey agar and require preservation of the sample in boric acid, or in a refrigerator, for 24 hours prior to testing. This culture can then be isolated and used to identify the strain of bacteria causing the infection7.
Species identification is imperative in maternal UTIs. Different species have different levels of sensitivity to the various antibiotics available. E. coli, for example, shows 93% sensitivity to Nitrofurantoin but is only 86% sensitive to Fosfomycin. Selection of the correct treatment can ameliorate symptoms rapidly and reduce the possible complications for both mother and baby4. Many species of bacteria known to be responsible for UTIs have displayed resistance to antibiotics. Group B streptococcus has been shown to be 42% resistant to clindamycin4. The selection of antibiotics available to clinicians treating maternal UTI are already limited as many antibiotics have been associated with increased risk of miscarriage and birth defects independent of UTI1.
With the patient in mind, Randox provides clinicians with both laboratory and near patient testing solutions. Bringing to the market, to help eliminate distress and improve testing turnaround times, the Randox Urinary Tract Infection Array. It has the ability to detect 30 bacterial, fungal, and associated antibiotic resistance markers from a single urine sample in under four hours. This multiplex diagnostic tool can help detect specific bacterial and fungal strains known to cause UTI allowing laboratories to confidently diagnose patients in a timely manner, aiding with targeted treatments and helping to reduce risk of complications.
The Ongoing UTI Battle
Maternal UTI is a very common problem resulting in many fatalities and morbidities worldwide. It is crucial to identify and characterize these infections to limit the negative effects seen to both mothers and their children. Quick and efficient screening is paramount in the battle against bacteria to allow the prescription of targeted treatment. While antibiotics are often an effective weapon against UTIs, care should be taken when prescribing these treatments to pregnant women due to the potential adverse effects that have been reported. Furthermore, unnecessary treatments using antibiotics should be avoided at all costs due to the increasingly serious issue of antimicrobial resistance.
References
1.Eslami V, Belin S, Sany T, Ghavami V, Peyman N. The relationship of health literacy with preventative behaviours of urinary tract infection in pregnant women. Journal of Health Literacy. 2022;6(4):22-31. doi:https://doi.org/10.22038/jhl.2021.59768.1183
2.Bien J, Sokolova O, Bozko P. Role of Uropathogenic Escherichia coli Virulence Factors in Development of Urinary Tract Infection and Kidney Damage. International Journal of Nephrology. Published online 2012:1-15. doi:https://doi.org/10.1155/2012/681473
3.Werter DE, Kazemier BM, van Leeuwen E, et al. Diagnostic work-up of urinary tract infections in pregnancy: study protocol of a prospective cohort study. BMJ Open. 2022;12(9):e063813. doi:https://doi.org/10.1136/bmjopen-2022-063813
4.Balachandran L, Jacob L, Al Awadhi R, et al. Urinary Tract Infection in Pregnancy and Its Effects on Maternal and Perinatal Outcome: A Retrospective Study. Cureus. 2022;14(1). doi:https://doi.org/10.7759/cureus.21500
5.Bono MJ, Reygaert WC. Urinary Tract Infection. Nih.gov. Published 2018. https://www.ncbi.nlm.nih.gov/books/NBK470195/
6.World Health Organization. Preterm birth. Who.int. Published February 19, 2018. Accessed February 8, 2023. https://www.who.int/news-room/fact-sheets/detail/preterm-birth
7.Sinawe H, Casadesus D. Urine Culture. PubMed. Published 2021. https://www.ncbi.nlm.nih.gov/books/NBK557569/
8.Schrader SM, Botella H, Vaubourgeix J. Reframing antimicrobial resistance as a continuous spectrum of manifestations. Current Opinion in Microbiology. 2023;72:102259. doi:https://doi.org/10.1016/j.mib.2022.102259
9.Murray CJ, Ikuta KS, Sharara F, et al. Global Burden of Bacterial Antimicrobial Resistance in 2019: A Systematic Analysis. The Lancet. 2022;399(10325):629-655. doi:https://doi.org/10.1016/S0140-6736(21)02724-0
10.Ali J, Rafiq QA, Ratcliffe E. Antimicrobial resistance mechanisms and potential synthetic treatments. Future Science OA. 2018;4(4):FSO290. doi:https://doi.org/10.4155/fsoa-2017-0109
11.Nelson DW, Moore JE, Rao JR. Antimicrobial resistance (AMR): significance to food quality and safety. Food Quality and Safety. 2019;3(1):15-22. doi:https://doi.org/10.1093/fqsafe/fyz003
12.Myers AL. Curbside Consultation in Pediatric Infectious Disease : 49 Clinical Questions. Slack; 2012:4.
13.Oie S, Kamiya A, Hironaga K, Koshiro A. Microbial contamination of enteral feeding solution and its prevention. American Journal of Infection Control. 1993;21(1):34-38. doi:https://doi.org/10.1016/0196-6553(93)90205-i
7. Sinawe H, Casadesus D. Urine Culture. PubMed. Published 2021. https://www.ncbi.nlm.nih.gov/books/NBK557569/
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Free Health Testing For Sandwell Residents As Council Partner With Randox Health To Detect Early Warning Signs of Serious Illness
Sandwell Council partners with Randox Health to launch free health checks service
Sandwell Council initiative places prevention at the centre of healthcare
Thousands of eligible Sandwell residents are being offered diagnostic NHS Health Checks to detect any early signs of diabetes, heart and kidney disease and hypertension.
The early identification of individuals with the potential to develop these conditions will enable the NHS to intervene and, in many cases, prevent the onset of potentially life-changing and life-threatening illnesses.
In a pioneering initiative, the Sandwell tests and online self-assessment provision will be provided by a partnership comprising the council’s Healthy Sandwell team, the NHS and diagnostics company Randox Health – whose tests and clinics will be used to facilitate the innovative testing. Tests and clinics will be available for Sandwell residents in both Sandwell and, if convenient, in Birmingham.
The awarding of the contract to Randox Health to provide the tests follows an open tender process by Sandwell Council. The company has demonstrated success in providing 17 million PCR tests to NHS Test and Trace during the Covid-19 pandemic, helping prevent thousands of hospitalisations and deaths in the UK.
Free tests will be offered to Sandwell residents aged between 40 and 74 who have not previously suffered coronary heart disease, strokes, diabetes or kidney disease. Each will, in the next few weeks, begin receiving letters inviting them to the 20-minute NHS check, with branding from Randox, Healthy Sandwell and the NHS. The letter will include a link to the Randox website through which the tests can be booked.
Sandwell residents who have not yet received a GP letter and believe they are eligible can visit the Randox website https://nhshealthcheck.randox.com, take an eligibility check and then book their own appointment.
Tests will be carried out by specially trained staff at a number of community pop-up clinics in locations in Sandwell such as leisure centres and community spaces, aiming to reach those most at risk of having an undiagnosed serious illness.
Tests for Sandwell residents will also be available at Randox Health’s Birmingham Clinic (39-40 High Street, B4 7SL).
Test results will be made available to GPs for inclusion on patient medical records through Health Diagnostics Ltd, a third-party provider. Randox will hold none of the data from the test results.
Not only will the testing programme enable prevention and mitigation through the early identification of serious illness, it will also allow lifestyle modification on issues including smoking, alcohol and weight management.
Councillor Suzanne Hartwell, Sandwell Council’s Cabinet Member for Adults, Social Care & Health, said:
David Ferguson, Chief Operating Officer for Randox Health said:
Editors Notes
1. Sandwell Council
Sandwell Council will participate in the partnership through Healthy Sandwell, which is part of the council’s Public Health team. Healthy Sandwell provides a range of services to support local people to make positive lifestyle changes, such as quitting smoking or losing weight. Further information: https://www.healthysandwell.co.uk/
2. Randox Health
Established in 1982, Randox is the largest healthcare diagnostics company from the UK and Ireland.
Undertaking research, development, manufacture and distribution of innovative laboratory tests and analysers, Randox provides 15% of all worldwide cholesterol tests and 10% of all clinical chemistry tests. More than 5% of the world’s population (over 370 million people) receive medical diagnosis using Randox products each year.
Randox Health focuses on the provision of timely and accurate testing to identify risk to health, improve clinical diagnoses and promote preventative healthcare; aiming to achieve better healthcare outcomes whilst reducing the burden on clinical services.
In early 2020 Randox recognised the threat from COVID-19 and quickly developed a test to accurately identify the virus. Testing at scale commenced within weeks to support the UK’s National Testing Programme and private clients. Randox has processed more than 25 million gold-standard PCR tests for the National Testing Programme and private COVID testing for travel.
Randox Health is clear that better diagnostics are unquestionably critical to future improvements within healthcare and is committed to remaining at the forefront of that field.
Its growing network of High Street clinics now operate in 20 locations around the UK and Ireland, including Birmingham.
