Rapid Susceptibility Testing Methods - 03/08/19

Doi : 10.1016/j.cll.2019.04.001

Kenneth P. Smith, PhD ^a, James E. Kirby, MD, D(ABMM) ^b,^c,^⁎
^a Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Center for Life Science, 3 Blackfan Circle-CLS624, Boston, MA 02115, USA
^b Clinical Microbiology, Department of Pathology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue-YA309, Boston, MA, USA
^c Harvard Medical School, Boston, MA, USA

^∗Corresponding author. Department of Pathology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue-YA309, Boston, MA.Department of PathologyBeth Israel Deaconess Medical Center330 Brookline Avenue-YA309BostonMA

Résumé

With emerging antimicrobial resistance, rapid antimicrobial susceptibility testing (AST) is needed to provide early definitive therapeutic guidance to optimize patient outcome. Genotypic methods are fast, but can identify only a subset of known resistance elements. Phenotypic methods determine clinically predictive minimal inhibitory concentrations and include very sensitive optical and biophysical methods to detect changes in replication or physiology of pathogens in response to antibiotics. For the potential of rapid AST to be fully realized, results must be linked with robust decision support solutions that will implement therapeutic changes in real time.

Le texte complet de cet article est disponible en PDF.

Keywords : Rapid antimicrobial susceptibility testing, Antimicrobial resistance, Phenotypic, Genotypic

Plan

Key points

Introduction

From reference to commercial methods: current state

With emerging antimicrobial resistance, timeliness becomes important

Rapid susceptibility landscape overview

Genotypic testing

The gram-positive/negative genotypic divide

Challenges of rapid phenotypic antimicrobial susceptibility testing

Microscopy-based rapid phenotypic antimicrobial susceptibility testing

Microscopy plus microfluidics

Alternative optical detection methods

Spectrometry-based detection

Signal amplification

Decision support must go hand in hand with rapid antimicrobial susceptibility testing implementation

Summary

Disclosure Statement: J.E. Kirby is a member of the Clinical Advisory Board of First Light Biosciences, Chelmsford, MA. TECAN (Morrisville, NC) provided an HP D300 digital dispenser and associated consumables used by JEK's research group during development of the MAST platform. Neither First Light nor TECAN had a role in article preparation or decision to publish.