Abstract
Infectious disease management essentially consists in identifying the microbial cause(s) of an infection, initiating if necessary antimicrobial therapy against microbes, and controlling host reactions to infection. In clinical microbiology, the turnaround time of the diagnostic cycle (>24 hours) often leads to unnecessary suffering and deaths; approaches to relieve this burden include rapid diagnostic procedures and more efficient transmission or interpretation of molecular microbiology results. Although rapid nucleic acid-based diagnostic testing has demonstrated that it can impact on the transmission of hospital-acquired infections, we believe that such life-saving procedures should be performed closer to the patient, in dedicated 24/7 laboratories of healthcare institutions, or ideally at point of care. While personalized medicine generally aims at interrogating the genomic information of a patient, drug metabolism polymorphisms, for example, to guide drug choice and dosage, personalized medicine concepts are applicable in infectious diseases for the (rapid) identification of a disease-causing microbe and determination of its antimicrobial resistance profile, to guide an appropriate antimicrobial treatment for the proper management of the patient. The implementation of point-of-care testing for infectious diseases will require acceptance by medical authorities, new technological and communication platforms, as well as reimbursement practices such that time- and life-saving procedures become available to the largest number of patients.
Highlights
Despite significant advances in sanitation and medicine, infectious diseases still annually claim in excess of 15 million lives
Hospital-acquired infections have become a major concern in healthcare facilities worldwide, their management being greatly complicated by the emergence of resistant and multiresistant Gram-positive and Gram-negative (E. coli, Klebsiella pneumoniae, Enterobacter spp., Serratia marcescens, Pseudomonas aeruginosa, and Acinetobacter baumanii) pathogens [4]
CLIA-waived personalized medicine specific real-time polymerase chain reaction (rtPCR)-based microfluidic devices which could be operated at POC by anyone, even the patient, technology developers shall elaborate very strict requirements to enable the approval of multiparametric devices bearing diagnostic microarrays having the potential to perform more tests per unit of time and augment the probability of detection of a sepsis-associated microbe, for example
Summary
Despite significant advances in sanitation and medicine, infectious diseases still annually claim in excess of 15 million lives. As in the times of Louis Pasteur, the identification of a microbe causing an infection may still require 2–3 days since the penetrance of rapid molecular diagnostics has been limited by a number of factors, such as cost and cultural resistance. This lack of speed in clinical microbiology has led to empirical therapy practices to which the emergence of superresistant microbes can be attributed for the most part. Other confounding factors contributing to the evolution and dissemination of emerging and multiresistant pathogens on the global scale have been identified by Morens et al [7]
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