Ann Lab Med.  2013 Jan;33(1):14-27. 10.3343/alm.2013.33.1.14.

Rapid Clinical Bacteriology and Its Future Impact

• van Belkum A
• Durand G
• Peyret M
• Chatellier S
• Zambardi G
• Schrenzel
• Shortridge D
• Engelhardt A
• Dunne WM

• KMID: 1781293
• DOI: http://doi.org/10.3343/alm.2013.33.1.14

Abstract

Clinical microbiology has always been a slowly evolving and conservative science. The sub-field of bacteriology has been and still is dominated for over a century by culture-based technologies. The integration of serological and molecular methodologies during the seventies and eighties of the previous century took place relatively slowly and in a cumbersome fashion. When nucleic acid amplification technologies became available in the early nineties, the predicted "revolution" was again slow but in the end a real paradigm shift did take place. Several of the culture-based technologies were successfully replaced by tests aimed at nucleic acid detection. More recently a second revolution occurred. Mass spectrometry was introduced and broadly accepted as a new diagnostic gold standard for microbial species identification. Apparently, the diagnostic landscape is changing, albeit slowly, and the combination of newly identified infectious etiologies and the availability of innovative technologies has now opened new avenues for modernizing clinical microbiology. However, the improvement of microbial antibiotic susceptibility testing is still lagging behind. In this review we aim to sketch the most recent developments in laboratory-based clinical bacteriology and to provide an overview of emerging novel diagnostic approaches.

Keyword

Antimicrobial susceptibility testing (AST); Antibiotics; Antibiogram; Drug resistance; Laboratory automation; DNA testing; MALDI-TOF MS; Innovation

MeSH Terms

Bacteria/*genetics/isolation & purification/metabolism
Bacterial Infections/diagnosis/*microbiology
Electronic Nose
High-Throughput Nucleotide Sequencing
Humans
Mass Spectrometry
Molecular Diagnostic Techniques
Nucleic Acid Amplification Techniques

Figure

• 

  Fig. 1 Schematic review of activities and procedures in the classical microbiology laboratory (green box). Essential pre-analytical and preparatory steps are given in light blue. Molecular technological innovation is indicated by the grey insertions in the green box, whereas the yellow box identifies host rather than infectious agent testing. The striped box in the middle relates to the recent but central position of novel technologies in the improvement of both host and agent specific testing which in the end should lead to personalization of infectious disease detection and treatment. Finally in dark blue: the central patient-oriented paradigm in the current evolution of microbial diagnostic services.

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