In a pandemic era, rapid infectious disease diagnosis is essential. Surface-enhanced Raman spectroscopy (SERS) promises sensitive and specific diagnosis including rapid point-of-care detection and drug susceptibility testing. SERS utilizes inelastic light scattering arising from the interaction of incident photons with molecular vibrations, enhanced by orders of magnitude with resonant metallic or dielectric nanostructures. While SERS provides a spectral fingerprint of the sample, clinical translation is lagged due to challenges in consistency of spectral enhancement, complexity in spectral interpretation, insufficient specificity and sensitivity, and inefficient workflow from patient sample collection to spectral acquisition. Here, we highlight the recent, complementary advances that address these shortcomings, including (1) design of label-free SERS substrates and data processing algorithms that improve spectral signal and interpretability, essential for broad pathogen screening assays; (2) development of new capture and affinity agents, such as aptamers and polymers, critical for determining the presence or absence of particular pathogens; and (3) microfluidic and bioprinting platforms for efficient clinical sample processing. We also describe the development of low-cost, point-of-care, optical SERS hardware. Our paper focuses on SERS for viral and bacterial detection, in hopes of accelerating infectious disease diagnosis, monitoring, and vaccine development. With advances in SERS substrates, machine learning, and microfluidics and bioprinting, the specificity, sensitivity, and speed of SERS can be readily translated from laboratory bench to patient bedside, accelerating point-of-care diagnosis, personalized medicine, and precision health.

Identifying pathogens in complex samples such as blood, urine, and wastewater is critical to detect infection and inform optimal treatment. Surface-enhanced Raman spectroscopy (SERS) and machine learning (ML) can distinguish among multiple pathogen species, but processing complex fluid samples to sensitively and specifically detect pathogens remains an outstanding challenge. Here, we develop an acoustic bioprinter to digitize samples into millions of droplets, each containing just a few cells, which are identified with SERS and ML. We demonstrate rapid printing of 2 pL droplets from solutions containing S. epidermidis, E. coli, and blood; when they are mixed with gold nanorods (GNRs), SERS enhancements of up to 1500× are achieved.We then train a ML model and achieve ≥99% classification accuracy from cellularly pure samples and ≥87% accuracy from cellularly mixed samples. We also obtain ≥90% accuracy from droplets with pathogen:blood cell ratios <1. Our combined bioprinting and SERS platform could accelerate rapid, sensitive pathogen detection in clinical, environmental, and industrial settings.

Genetic analysis methods are foundational to advancing personalized medicine, accelerating disease diagnostics, and monitoring the health of organisms and ecosystems. Current nucleic acid technologies such as polymerase chain reaction (PCR) and next-generation sequencing (NGS) rely on sample amplification and can suffer from inhibition. Here, we introduce a label-free genetic screening platform based on high quality (high-Q) factor silicon nanoantennas functionalized with nucleic acid fragments. Each high-Q nanoantenna exhibits average resonant quality factors of 2,200 in physiological buffer. We quantitatively detect two gene fragments, SARS-CoV-2 envelope (E) and open reading frame 1b (ORF1b), with high-specificity via DNA hybridization. We also demonstrate femtomolar sensitivity in buffer and nanomolar sensitivity in spiked nasopharyngeal eluates within 5 minutes. Nanoantennas are patterned at densities of 160,000 devices per cm2, enabling future work on highly-multiplexed detection. Combined with advances in complex sample processing, our work provides a foundation for rapid, compact, and amplification-free molecular assays.

The presence of pathogens in complex, multi-cellular samples such as blood, urine, mucus, and wastewater can serve as indicators of active infection, and their identification can impact how human and environmental health are treated [1][2][3][4][5][6][7]. Surface-enhanced Raman spectroscopy (SERS) and machine learning (ML) can distinguish multiple pathogen species and strains [8][9][10][11], but processing complex fluid samples to sensitively and specifically detect pathogens remains an outstanding challenge. Here, we develop an acoustic bioprinting platform to digitize samples into millions of droplets, each containing just a few cells, which are then identified with SERS and ML. As a proof of concept, we focus on bacterial bloodstream infections. We demonstrate ∼2pL droplet generation from solutions containing S. epidermidis, E. coli, and mouse red blood cells (RBCs) mixed with gold nanorods (GNRs) at 1 kHz ejection rates; use of parallel printing heads would enable processing of mL-volume samples in minutes [12]. Droplets printed with GNRs achieve spectral enhancements of up to 1500x compared to samples printed without GNRs. With this improved signal-to-noise, we train an ML model on droplets consisting of either pure cells with GNRs or mixed, multicellular species with GNRs, using scanning electron microscopy images as our ground truth. We achieve ≥99% classification accuracy of droplets printed from cellularly-pure samples, and ≥87% accuracy in droplets printed from mixtures of S. epidermidis, E. coli, and RBCs. We compute the feature importance at each wavenumber and confirm that the most significant spectral bands for classification correspond to biologically relevant Raman peaks within our cells. This combined acoustic droplet ejection, SERS and ML platform could enable clinical and industrial translation of SERS-based cellular identification. MainReliable detection and identification of microorganisms is crucial for medical diagnostics, environmental monitoring, food production and safety, biodefense, biomanufacturing, and pharmaceutical development. Such samples typically contain as few as 1-100 colony-forming units (CFU)/mL[13-15], necessitating the use of in vitro liquid culturing for pathogen detection. It is estimated that less than 2% of all bacteria can be readily cultured using current laboratory protocols, and even amongst that 2%, culturing can take hours to days depending on the species [16][17][18][19]. In the case of medical diagnostics, broad spectrum antibiotics are often administered while waiting for culture results, leading to an alarming rise in antibiotic resistant bacteria. Antimicrobial resistance currently leads to ∼700,000 deaths per year, and is predicted to become the leading cause of death by 2050 [20]. To combat these trends, it is crucial to develop methods to rapidly detect and identify bacteria in diverse, complex samples.Raman spectroscopy is a label-free, vibrational spectroscopic technique that has recently emerged as a promising platform for bacterial species