Council members press for surveillance and diagnostics to capture treatment failures and microbiome health

Multiple council members asked panelists whether public health systems can track treatment failures and microbiome metrics that matter for patient outcomes. Francisco Zagmutt asked about quantitative systems to follow treatment non-responsiveness across One Health sectors; Michael Craig said some categorizations (e.g., difficult-to-treat) exist but a full surveillance approach is not yet in place. "Is there any way to do surveillance for therapeutic non-responsiveness?" Craig asked; McDonald and other panelists said more work is needed.

McDonald suggested epidemiologic approaches (mortality, retrospective cohorts) and said electronic health records and improved data collection could help build surveillance for non-response. On diagnostics, Robin Patel asked whether a valid metric exists to say a microbiome has been 'restored'; McDonald said research groups are developing microbiome-disruption indices (for example, diversity measures and bile-salt physiology in C. difficile) but recommended outcome-specific metrics and regulatory encouragement for putative measures during product development.