Rapid diagnostics for skin and soft tissue infections: the current landscape and future potential

Abstract

Purpose of reviewManaging antimicrobial therapy in patients with complicated skin and soft tissue infections (SSTI) constitutes a growing challenge due to the wide spectrum of potential pathogens and resistance phenotypes. Today, microbiological documentation relies on cultural methods. This review summarizes the available evidence regarding the clinical input of rapid microbiological diagnostic tools (RMDT) and their impact on the management of antimicrobial therapy in SSTI.Recent findingsAccurate tools are already available for the early detection of methicillin-resistant Staphylococcus aureus (MRSA) in SSTI samples and may help avoiding or shortening empirical anti-MRSA coverage. Further research is necessary to develop and evaluate RMDT detecting group A streptococci (e.g., antigenic test) and Gram-negative pathogens (e.g., multiplex PCR assays), including through point-of-care utilization. Next-generation sequencing (NGS) methods could provide pivotal information for the stewardship of antimicrobial therapy, especially in case of polymicrobial or fungal SSTI and in the immunocompromised host; however, a shortening in the turnaround time and prospective data regarding their therapeutic input are needed to better appraise the clinical positioning of these promising approaches.SummaryThe clinical input of RMDT in SSTI is currently limited due to the scarcity of available dedicated assays and the polymicrobial feature of certain cases. NGS appears as a relevant tool but requires further developments before its implementation in routine clinical practice.

Current approach to skin and soft tissue infections. Thinking about continuity of care

“…The rapid diagnosis is currently the goal to be pursued by implementing techniques such as matrix assisted laser desorption ionization-time of flight, commercial real-time PCR or the promising next-generation sequencing methods. Rapid diagnostic tools and clinical metagenomics are under evaluation for the management of SSTI and will hopefully help tailoring antimicrobial therapy in a close future in patients with risk factors for MDRB [ 29 , 41 ]. Identifying the optimal empirical antimicrobial regimen in patients with SSTI is increasingly challenging due to the rising prevalence of MDRB as the causative pathogens of these infections and (more generally) the growing population of individuals at-risk for MDRB-related condition.…”