Given the complex nature of diagnostic practices for infectious diseases, the one unifying characteristic of the agents investigated is their possession of a genome. While many molecular diagnostic tests investigate parts of the genome, whole-genome sequencing (WGS) has emerged as a cost-effective and convenient approach for answering the varied microbiological questions that arise. In that regard, four essential tasks are addressed: species identification, phenotypic characterization, e.g., antimicrobial resistance and virulence, evolutionary traits and pathogen tracking. Some of the benefits already available include, in addition to the ability to fully characterize prospective and retrospective isolates, the ability to be applied directly to clinical samples for simultaneous identification and predicting antimicrobial susceptibilities (even in culture-negative cases); identification in polymicrobial samples; generating regional phylogenomic sublineages; correlation of genomic features with strains of clinical importance; tracking of multidrug resistant organisms in hospitals and communities. These benefits, while largely seen in reports from North America and Europe, are also being observed in Latin America and the Caribbean. Further, WGS allows for estimation of mutation rates among isolates, as well as assessment of the rates and breadth of horizontal gene flow within and between species, the evolution of new virulence traits, and the role of host genetics in host-pathogen interactions, all with the view to develop novel therapeutic interventions. The main directions of WGS applications include diagnosis and control of local and regional infectious diseases; detection of multidrug resistance (MDR) and virulence characteristics; surveillance of pathogen evolution and transmission dynamics; development of new (portable) diagnostic tests and assays for use in clinics and outpatient facilities; and discovery of novel antimicrobial drugs and therapeutics and assessment of their prevention and control. Given that pathogens occur in complex microbial communities, further elaborations to explore the pathobiome using metagenomics and high-throughput sequencing will assist with the understanding of the forces supporting population structure, including pathogen plasticity.
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