Rapid susceptibity test for UTI receives prize and recognition

PA-100 AST System a rapid antimicrobial susceptibility test for urinary tract infections (UTIs) has been awarded Longitude Prize. The test developed at Sweden's Uppsala University uses nanofluidic technology to detect bacteria in a urine sample in 15 minutes and identify the right antibiotic in as little as 45 minutes, and requires no specialized laboratory testing expertise.

Following a decade of developments, and entries from more than 250 teams around the world, the £8m Longitude Prize on AMR has been awarded by Challenge Works (part of innovation agency Nesta) to the PA-100 AST System from Sysmex Astrego.

The Longitude Prize on AMR launched in 2014 to incentivise the creation of new diagnostic tests that, in a matter of minutes, can identify whether an infection is bacterial, and if so, the right antibiotic to prescribe to slow the spread of antibiotic resistant infections. The goal is to replace the 2-3 day lab test process that doctors and patients must currently endure, and end “just in case” prescribing that is prevalent as a result, which promotes the development of antibiotic resistance.

The PA-100 AST System is an innovative diagnostic test based on technology from Uppsala University. The test will transform the treatment of UTIs (urinary tract infections) and brings the power of laboratory testing into a doctor’s office.

Using a tiny (400 microlitre/less than half a millilitre) sample of urine on a smartphone-sized cartridge, the test can identify the presence of a bacterial infection in just 15 minutes and accurately identify the right antibiotic to treat it within 45 minutes. This supports doctors and health workers in their clinical decision making at the point of care, and opens up the significant possibility of previously “retired” first-line antibiotics coming back into use for the majority of patients.

Dame Sally Davies, UK Special Envoy on Antimicrobial Resistance, former Chief Medical Officer of England and Longitude committee member said:

“Without antibiotics, modern medicine as we know it is in real danger of collapse. Every day, healthcare workers make urgent clinical judgements for the good of their patients, but we can no longer afford ‘just-in-case’ prescribing of antibiotics. The Longitude Prize winner lays the groundwork for a sea-change in how we manage these precious medicines, where healthcare workers are supported with rapid and relevant diagnostic tests to make the best decisions for their patients with confidence that they are prescribing the right drug, first time.”

Antimicrobial Resistance (AMR) – also known as antibiotic resistance or superbugs – is a silent, growing and devastating pandemic where bacteria have developed resistance to the lifesaving antibiotics at the heart of modern medicine, following a century of unnecessary or untargeted prescriptions. In 2019, antibiotic resistant infections directly killed 1.3m people around the world and contributed to the deaths of 5m in total. By 2050 it is predicted antibiotic resistant infections will cause 10m deaths annually. The World Bank estimates antibiotic resistance could result in $1tn in additional health costs by 2050 and up to $3.4tn in lost GDP by 2030.

Around 50-60% of women will develop a UTI in their lifetime, and one in 10 women aged 18 and over report at least one presumed UTI annually. UTIs are the most common bacterial infection treated by the NHS in England – and up to half of infection-causing bacteria are resistant to at least one antibiotic. Treating unplanned hospital admission for UTIs cost the NHS £386m in 2017/18. In 20-30% of sepsis patients, the infection originates from the urinary tract, and urosepsis often develops from UTIs – up to two in five people that develop severe sepsis will go on to lose their lives.

Mikael Olsson, CEO and co-founder, Sysmex Astrego, winners of the Longitude Prize on AMR said:

“The PA-100 AST System challenges bacteria present in a patient’s urine with microscopic quantities of antibiotics in tiny channels embedded in a cartridge the size of a smartphone. We rapidly pinpoint whether a bacterial infection is present and identify which antibiotic will actually kill the bugs, guiding doctors only to prescribe antibiotics that will be effective. We have already started rolling out the test in Europe, we’re running studies in surgeries across the UK and working with regulators to secure additional approvals. The £8m prize will support us to tailor the test for use with different kinds of UTIs and antibiotics, speeding up access for more patients.”

Dr Sherry Taylor, GP Partner at NHS practice Temple Fortune Medical Group in London said:

“Currently I send the urine sample off for analysis and it usually takes around three days to come back with results, if we get results back that differ to our prescription then we have to ring the patient back to change them to the correct antibiotic. Having a bedside test that would enable rapid diagnosis through antibiotic susceptibility testing[9] would revolutionise general practice and patient care. It would be amazing – it’s all about using antibiotics only when necessary and appropriate.”

The cartridge, containing a nanofluidic chip, is inserted into an analyser unit – about the size of a shoebox – which reads the chip sample at a cellular level. Designed to work in doctor’s offices, the analyser unit is fully automatic and maintenance free. It is the first time a point-of-care test is capable of identifying a specific infection and its susceptibility to specific drugs by observing how the patient’s infection responds in real-time to different antibiotics (a phenotypic test).

The PA-100 AST System creates a future where patients can quickly and accurately get a diagnosis and the correct treatment when they visit the doctor. Accurate, rapid diagnosis of bacterial infections that help doctors and health workers to manage and target antibiotics, will slow the development and spread of antibiotic resistant infections, improve healthcare and save potentially millions of lives.

Roughly 25-30% of patients have infections resistant to older first-line antibiotics which have been retired as a result; this means the remaining 70-75% of patients could still benefit from those older drugs. Since the PA-100 AST System identifies which specific antibiotic can treat an infection, it will likely allow retired antibiotics to be brought back into service because the test is able to demonstrate when an infection is susceptible to their effects.

The winning test paves the way for a future where the PA-100 AST System and similar technologies can transform infection diagnosis and treatment beyond UTI, through, for example, blood and sputum (saliva) tests to detect other infections.

Johan Elf PhD, Founder of Astrego Diagnostics, Professor of Physical Biology at Uppsala University said:

“The Longitude Prize has been incredibly important in shaping the PA-100 system. We were working on developing measurement technology exclusively to answer basic science questions and when we heard about the Longitude Prize, we realised that the technology could be really useful in the fight against AMR, and the prize criteria have guided our work to develop a transformative test.”

The Longitude Prize on AMR is designed and delivered by Challenge Works – a Nesta enterprise. For more than a decade, Challenge Works has run 86 prizes, distributed £124 million in funding and engaged with 13,500 innovators across prizes tackling major health challenges, frontier technology, global sustainability and social impact.

Challenge Prizes offer a large reward to incentivise the development of breakthrough innovations to tackle challenges where solutions have not been forthcoming. As an open innovation competition, it levels the playing field for disruptive start-ups and new entrants who are often overlooked by traditional grant funding – attracting new talent and new ideas to solve a problem.

Tris Dyson, Managing Director, Challenge Works said:

“We launched the Longitude Prize on AMR to create the urgent ‘pull’ needed to get innovators working on one of the biggest life-and-death challenges facing humanity. Hundreds of teams competed, with multiple solutions now close to market thanks to the prize. I want this to be the start of a revolution in healthcare where rapid point of care diagnostics become a mainstay of medicine – creating a future where patients can quickly and accurately get a diagnosis and the correct treatment when they visit the doctor. The success of the Longitude Prize on AMR opens the door for many more prizes to tackle massive global challenges. Today’s news proves that, when there is a challenge of gargantuan proportions in desperate need of real-world solutions, prizes attract the brightest minds to solve the problem and leave a legacy of successful, growing businesses in their wake.”