Modern Tools for Rapid Diagnostics of Antimicrobial Resistance

Abstract

Fast, robust, and affordable antimicrobial susceptibility testing (AST) is required, as roughly 50% of antibiotic treatments are started with wrong antibiotics and without a proper diagnosis of the pathogen. Validated growth-based AST according to EUCAST or CLSI (European Committee on Antimicrobial Susceptibility Testing, Clinical Laboratory Standards Institute) recommendations is currently suggested to guide the antimicrobial therapy. Any new AST should be validated against these standard methods. Many rapid diagnostic techniques can already provide pathogen identification. Some of them can additionally detect the presence of resistance genes or resistance proteins, but usually isolated pure cultures are needed for AST. We discuss the value of the technologies applying nucleic acid amplification, whole genome sequencing, and hybridization as well as immunodiagnostic and mass spectrometry-based methods and biosensor-based AST. Additionally, we evaluate the potential of integrated systems applying microfluidics to integrate cultivation, lysis, purification, and signal reading steps. We discuss technologies and commercial products with potential for Point-of-Care Testing (POCT) and their capability to analyze polymicrobial samples without pre-purification steps. The purpose of this critical review is to present the needs and drivers for AST development, to show the benefits and limitations of AST methods, to introduce promising new POCT-compatible technologies, and to discuss AST technologies that are likely to thrive in the future.

Fighting Antibiotic Resistance in Hospital-Acquired Infections: Current State and Emerging Technologies in Disease Prevention, Diagnostics and Therapy

“…The method is based on disk diffusion with shortened incubation times of 4–8 h and was extensively validated in clinical labs across 55 European countries ( Åkerlund et al, 2020 ). A plethora of rapid diagnostic tools based on molecular methods such as fluorescence microscopy, proteins detection, hybridization, nucleic acid amplification technologies, and immunodetection are being currently developed [reviewed in detail in Vasala et al (2020) and van Belkum et al (2020) ]. Here we will give an overview on gold standard rapid diagnostics, genotypic (detect potential antibiotic resistance), and phenotypic (detect actual antibiotic resistance) point-of-care tools approved by FDA and touch on emerging technologies for future rapid diagnostics ( Table 1 ).…”

Rapid Methods for Antimicrobial Resistance Diagnostics

“…Another advantage is the elimination of isolate purification since non-purified polymicrobial samples can be used. Moreover, they allow for relatively quick adaptation to newly introduced resistance factors [ 27 ]. Nevertheless, molecular-based assays for AMR detection have some limitations.…”

New Microbiological Techniques for the Diagnosis of Bacterial Infections and Sepsis in ICU Including Point of Care

“…Advances in microfluidics, electronics, optic and biosensor techniques are promising approaches for next-generation rapid AST and at the early stages of translation into practice. Evidences on their role to address point of care testing (POCT) needs, however, are still scarce, and studies are still in progress to achieve FDA approval and CE mark [ 94 ].…”