Abstract
With the development of next generation sequencing technologies in recent years, it has been demonstrated that many human infectious processes, including chronic wounds, cystic fibrosis, and otitis media, are associated with a polymicrobial burden. Research has also demonstrated that polymicrobial infections tend to be associated with treatment failure and worse patient prognoses. Despite the importance of the polymicrobial nature of many infection states, the current clinical standard for determining antimicrobial susceptibility in the clinical laboratory is exclusively performed on unimicrobial suspensions. There is a growing body of research demonstrating that microorganisms in a polymicrobial environment can synergize their activities associated with a variety of outcomes, including changes to their antimicrobial susceptibility through both resistance and tolerance mechanisms. This review highlights the current body of work describing polymicrobial synergism, both inter- and intra-kingdom, impacting antimicrobial susceptibility. Given the importance of polymicrobial synergism in the clinical environment, a new system of determining antimicrobial susceptibility from polymicrobial infections may significantly impact patient treatment and outcomes.
Highlights
With recent developments in sequencing technologies, it has been shown that many infections can be polymicrobial in nature, potentially leading to worse patient outcomes.Current routine clinical models, focus on unimicrobial culture-based methods to determine the causative agent
Of those in the bacteria-only failure group, 75% had bacteria with pre-existing resistance to the prescribed antibiotic, whereas 66% of the co-infected group’s bacteria were susceptible when evaluated using the Kirby-Bauer disk diffusion method [43]. This would seem to indicate that bacteria–virus co-infection is producing an effect on the antimicrobial susceptibility of the bacteria, but it is far less certain whether or not that effect relates more to the possible indirect immune suppression of the host due to the concomitant viral infection or due to the direct interactions of those two microorganisms with each other
Even though it has been repeatedly demonstrated that biofilm-associated infections and/or a polymicrobial environment affect the susceptibility of bacteria to antibiotics, the current mode of antibiotic susceptibility testing (AST) determination does not reflect those conditions
Summary
With recent developments in sequencing technologies, it has been shown that many infections can be polymicrobial in nature, potentially leading to worse patient outcomes. Focus on unimicrobial culture-based methods to determine the causative agent. It is well-known that many chronic infections are often polymicrobial in nature [1]. Developed generation sequencing (NGS) technologies have led to increased understanding of polymicrobial infections, as they have helped to eliminate culture-bias in microbial identification. Culture-based microbial identification is a common method used in clinical laboratories to identify the microorganisms in samples [2]. With NGS helping to more accurately identify the microorganisms in samples, it is being demonstrated that more infections are polymicrobial than was previously recognized.
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