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Next-generation water testing for the European market (NG-WTEM)

Periodic Reporting for period 1 - NG-WTEM (Next-generation water testing for the European market (NG-WTEM))

Reporting period: 2019-03-01 to 2019-11-30

The proposed project investigated feasibility of WaterScope’s current system in the European market, in particular for the regulatory and contractual water testing market. WaterScope is a Cambridge University spin-out developing a rapid, simple to use water testing system for the developing world. The system has been trialled in one of the largest refugee camps in the modern world, and the organisation has won the University of Cambridge, Vice Chancellor’s Overall Impact Award. WaterScope has raised over £460,000 of non-dilutive funding from grants and competitions. The proposed project is to investigate the use of our technology in the European market to expand identify a developed world market that our existing system can translate into. WaterScope’s automated testing system allows for a much faster test, with results obtained in less than 6 hours - quicker than anything on the market at the moment - with results automatically quantified. In addition to this WaterScope’s novel cartridge makes sample preparation simple, significantly reducing human error and sample preparation times.

In the project we identified the key stakeholders in the market, including distributors, manufacturers, water testing labs and customers of water testing labs. With testing frequency increasing due to EU regulation, we approached customers of water testing labs to identify whether this was a viable market, to offer on-site testing to companies who would typically send samples to labs. We visited a company in Germany who represented a typical customer of water testing labs, as well as one of the largest water testing labs in the UK. With interviews from customers and water testing labs, we identified that this market is not suitable for our technology. Largely this is due to the large requirement of a testing system to be able to conduct a range of tests which requires significant R&D to implement.

Through contacts at the University of Cambridge, we identified urinary tract infections (UTI) as a potential market. Almost all patients with a suspected UTI will receive broad-spectrum antibiotics after testing with a dipstick in GP surgeries. Over two-thirds of patients that are prescribed antibiotics in the UK do not show evidence of UTI infection, which is greatly increasing the burden of antimicrobial resistance. Current methods to test for UTI include bacterial culture and antimicrobial susceptibility tests, usually conducted in centralised diagnostic laboratories. In the UK, over 600,000 UTIs occurred between 2013-2015; globally it was estimated that 92 million people were affected in 2013. The requirement of external triage results in a large cost to the NHS, and slow turnaround; with patients unable to wait 2-5 days the best course of action is to prescribe broad-spectrum antibiotics in GP surgeries. Our solution is to develop a compact desktop system to bring near-patient testing of antibiotic susceptible bacteria in UTIs into GP surgeries or care homes. With a disposable cartridge and a compact desktop microscope that automates colony culture and antimicrobial susceptibility testing, we can simplify testing and allow it to be performed outside diagnostic microbiology laboratories, whilst giving comparable results. This allows the correct antibiotics to be prescribed to the patient within hours rather than days. We successfully conducted a proof-of-concept in the lab and applied for funding (£120,000 to run a small scale clinical study in March 2020 which was successful, to further this project.
The project spanned nine months. In the first three months, we interviewed customers that require their water testing, distributors of water testing kits and lab supplies, manufacturers of water testing kits and lab supplies, and water testing labs. This allowed us to understand the demands and needs of the sector as a whole, and where our technology would be most appropriate. We met with a customer in Germany who expressed an interest to conduct onsite testing, due to the increasing costs and slow turn around of sending samples to testing labs. We conducted a small proof of concept of our system as an onsite test with some success, being able to identify bacterial contamination rapidly and onsite. However, through further conversations, we identified that for a test to be financially viable to the customer, it must be able to conduct a test for numerous bacterial types, similar to the battery of tests water testing labs conduct. We reviewed the functionality of our system and concluded to include the tests necessary to make it financially attractive is too much of a risk technically. After conversations with testers and customers, who echoed this feedback, we concluded that this market was heavily contingent of being able to test for numerous contaminants and therefore decided that using our system as a rapid water testing system in the developed world was not a viable market at our current stage.

Next, from month four, through nine, we investigated our system as a medical diagnostic. Through contacts at the University of Cambridge, we identified urinary tract infection testing as a potential market. We conducted an initial proof-of-concept with much success, being able to identify bacterial growth from urine samples rapidly. To understand the users' needs and requirements we conducted a focus group with general practitioners, urologists and urinary testing lab microbiologists. We identified that the system needs to be able to identify antibiotic susceptibility rapidly to be able to be used as a point of care diagnostic.
Importantly this project allowed us to identify whether the water testing market was a viable market for our technology at our current stage, quickly. Further through this project, we identified a new market in the medical market with our device as a urinary tract infection diagnostic. As a result of the project activities, we were successful in achieving follow-on funding to demonstrate this technology in a clinical setting. The project will prime us to obtain larger funding for commercialisation, to demonstrate a full-scale clinical trial as well as allow us to precisely define the final commercial product and identify the first initial market entry point. We are will publish a peer-reviewed paper demonstrating our system as a urinary tract diagnostic in late 2020.

The Urinary Tract Infection analysis market is valued at $3.2Billion and growing rapidly to $4.6 billion by 2024. Our solution will bring near-patient testing of antibiotic susceptible bacteria in UTIs into care homes or GP surgeries. Our initial end users will be care home practitioners in care homes who will now be able to prescribe the most appropriate antibiotics for patients.

Customers (Healthcare provider) benefits:
• Avoid transport/outsourcing costs and delays
• Rapid results for same-day decision-making
• Evidence-based antibiotic prescription reducing potential complications. For example, the mean cost per
hospitalised UTI case is estimated as £5000.
• Same day decision making for effective treatment
• Avoidance of unnecessary or broad-spectrum antibiotic treatment
(minimising side-effects)

Societal benefits:
• Rapid diagnosis of UTI in community settings
• Improved antimicrobial stewardship
• Reduction in antimicrobial resistance/selection pressure resulting from reduced broad-spectrum antibiotic use.
Overview of WaterScope's Technology
Proposition for UTI testing
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