Rapid Diagnostics for Antibiotic Resistance: Urgent Need for Strong Clinical Evidence
Yin Mo
Abstract
Improving microbiological diagnostics is a key strategy in combating antibiotic resistance [1, 2]. Conventional laboratory methods typically take 2–5 days for bacterial pathogen isolation, identification, and antibiotic susceptibility testing. Rapid diagnostics may speed up etiologic diagnosis of infections and detect associated antimicrobial resistance within hours. When incorporated into clinical practice, rapid diagnostics hold the promise to improve patient outcomes through prompt administration of targeted antibiotic treatment and reduce unnecessary empiric broad-spectrum antibiotic consumption. Novel technology has emerged in recent decades to reduce or bypass laboratory steps required to identify antibiotic resistance in bacterial pathogens. These methods can be generally categorized into those that rapidly identify pathogen (eg, mass spectrometry, automated fluorescence in situ hybridization), those which detect resistance genes (eg, nucleic acid amplification tests, nucleic acid hybridization) or proteins (eg, lateral flow test), and rapid phenotypic tests (eg, early detection of bacterial response to antibiotics via time-lapsed microscopic imaging or flow cytometry) [3]. Many of these methods have been validated against reference conventional growth-based standards such as the European Committee on Antimicrobial Susceptibility Testing and Clinical Laboratory Standards Institute. However, assimilation of these rapid diagnostics into routine clinical care remains slow.