Jim Poggi
“In all things, balance. In balance there is harmony.”
That’s a little on the “zen” side, but balance is the best way to describe the relationship between the human immune system and the complex community of microbiota that surround us internally and externally. While we cannot see them with the naked eye and rarely think about them in daily life, the bacteria and other microorganisms on our skin, GI tract and in contact with our bodies are a living part of us. It’s becoming ever more apparent that a healthy balance of these microbiota is important to human health and wellness.
When the microbiota community is in balance, it is believed to have a positive impact on overall health and wellness. When that balance is upset by antibiotic therapy or an infection by a pathologic agent, bad consequences result, including sepsis and organ failure in extreme cases. There’s an emerging body of evidence that gastrointestinal microbiota have impacts on health far beyond the GI tract.
So, what does this all have to do with lab the POL and things of interest to distributor account managers? I was hoping you would ask. The short answer is that your customers see patients with a variety of symptoms caused by an infection, no matter whether they are in a primary care practice, a specialty practice, or work in an urgent care or ER setting. Some of the more common infections, along with the infectious agent and a brief listing of the most commonly used tests, are below.
Infections your customers care about
| Site of infection | Source of Infection | Test/Test Type | Comments |
| Upper respiratory tract | Group A strep, influenza, metapneumovirus, others | Lateral flow, molecular | The broadest range of waived and non-waived tests are aimed at this source of infection |
| Urinary tract | E. coli, staphylococcus, proteus, klebsiella, enterococcus, and pseudomonas | Routine urinalysis, urine culture, molecular | One of the most common infections, particularly in the elderly |
| Genitals | HIV, HPV, trichomonas, chlamydia, gonorrhea, syphilis, gardnerella, others | Lateral flow rapids, molecular | Some of the first molecular methods were targeted against these diseases |
| Skin (bacterial) | MRSA, staph, strep, others | Molecular, routine microbiology | Many of these diseases may lead to sepsis |
| Skin (tick, parasite) | Lyme disease, rocky mountain spotted fever, others | Lateral flow rapids, molecular | Rising in incidence; new diseases being uncovered |
| GI tract | HAV, HBV, HCV, H. pylori, C. diff | Lateral flow rapids, immunoassay, molecular | Both hospital acquired and community acquired infections are in this category |
When your customers care
Routinely, clinicians managing healthy patients for an annual physical or wellness exam see patients whose microbiota community are in balance and really do not even think about the impact of imbalance. But, for the symptomatic patient, whether they have respiratory, GI or other symptoms, suddenly the emergence of a pathogen and the apparent imbalance of the microbiota become a critical concern. When all is said and done, both the importance of understanding whether a patient has a bacterial or viral infection and understanding of which organism is the causative agent is a critical crossroad in diagnosis and treatment.
The remarkable advances in molecular testing have paved the way to enable testing for a far wider range of bacteria and viruses than ever before with results that are faster, more accurate and more actionable than we could have achieved fewer than 10 years ago. As you look through the eyes of your customers, probably the most meaningful change is this: New molecular methods, in combination with other advances in lab technology including procalcitonin and newer hematology system parameters aimed at helping to diagnose sepsis, mean that the customers we call on are better armed than ever to evaluate the cause of infection for a patient, whether the infection is respiratory, skin or wound based or enteric. This is a remarkable move forward. The clinician can now evaluate and diagnose the patient on a holistic basis, irrespective of where the infection resides.
Where your customers care
While respiratory infections and urinary tract infections are common reasons for patients to see their primary care physician, some of the other infections we are considering are more likely to be seen in a more acute care setting, including an urgent care, free standing emergency room or hospital-based emergency room. Many of the more painfully symptomatic GI and skin infections, including tick-based diseases, are first diagnosed in these settings. Genital infections tend to run the gamut from community healthcare clinics to private primary care to the emergency room depending on the severity of the symptoms. So, no matter what your call point or customer type, the clinicians you call on see some or all of the most common sources of infection and can benefit from a range of the solutions you and your valued suppliers can provide. The range of tests available has increased significantly and the speed and quality of the results provide easily accessible lab tests to help diagnose these infections.
Why you should care
In addition to growing our business, we are charged with helping our customers to provide the best available care to their patients and acting as a savvy and well-informed consultant. Spending time with your key suppliers and learning about the solutions they offer to the myriad infectious diseases our customers see every day is an excellent way to move beyond being an expert on flu and respiratory tests.
We can help our customers to create tremendous patient care value by accurate, early diagnosis of infections. We can help reduce the spread of contagious diseases in our community and reduce the possibility of development of sepsis from certain respiratory and skin infections. Accurately diagnosing Lyme and other tick-borne illnesses can lead to more effective treatment and reduce time to diagnosis, costs and patient suffering. Timely diagnosis and treatment of infections based on lab results is a critical element of antibiotic stewardship. Finally, no matter what the practice setting, the bottom line of timely accurate diagnosis of infection is better patient care. We’re key providers of the information and the tests available to improve health care to the clinicians we call on who see infections every day. Make a difference.