The
global prevalence of antibiotic-resistant bacteria has increased
the risk of dangerous infections, requiring rapid diagnosis and treatment.
The standard method for diagnosis of bacterial infections remains
dependent on slow culture-based methods, carried out in central laboratories,
not easily extensible to rapid identification of organisms, and thus
not optimal for timely treatments at the point-of-care (POC). Here,
we demonstrate rapid detection of bacteria by combining electrochemical
immunoassays (EC-IA) for pathogen identification with confirmatory
quantitative mass spectral immunoassays (MS-IA) based on signal ion
emission reactive release amplification (SIERRA) nanoparticles with
unique mass labels. This diagnostic method uses compatible reagents
for all involved assays and standard fluidics for automatic sample
preparation at POC. EC-IA, based on alkaline phosphatase-conjugated
pathogen-specific antibodies, quantified down to 104 bacteria
per sample when testing Staphylococcus aureus, Escherichia coli, and Pseudomonas aeruginosa lysates. EC-IA quantitation
was also obtained for wound samples. The MS-IA using nanoparticles
against S. aureus, E.
coli, Klebsiella pneumoniae, and P. aeruginosa allowed selective
quantitation of ∼105 bacteria per sample. This method
preserves bacterial cells allowing extraction and amplification of
16S ribosomal RNA genes and antibiotic resistance genes, as was demonstrated
through identification and quantitation of two strains of E. coli, resistant and nonresistant due to β-lactamase
cefotaximase genes. Finally, the combined immunoassays were compared
against culture using remnant deidentified patient urine samples.
The sensitivities for these immunoassays were 83, 95, and 92% for
the prediction of S. aureus, P. aeruginosa, and E. coli or K. pneumoniae positive culture,
respectively, while specificities were 85, 92, and 97%. The diagnostic
platform presented here with fluidics and combined immunoassays allows
for pathogen isolation within 5 min and identification in as little
as 15 min to 1 h, to help guide the decision for additional testing,
optimally only on positive samples, such as multiplexed or resistance
gene assays (6 h).