New and novel rapid diagnostics that are impacting infection prevention and antimicrobial stewardship

Abstract

Purpose of review The current review summarizes advances in rapid diagnostic testing that impacts infection prevention and antimicrobial stewardship programs. Recent findings A variety of rapid diagnostic technologies to identify organisms in cultured blood are now available. When coupled with antimicrobial stewardship (ASP), these rapid technologies can optimize antimicrobial utilization and patient outcomes. Two rapid molecular panels that detect organisms related to pneumonia are available and may impact infection prevention surveillance definitions. Three molecular tests are available for the detection of meningitis and encephalitis pathogens. Still, the clinical impact of these broad, multiplexed panels need additional clarification. For Clostridioides difficile infections, ultrasensitive toxin A/B assays may provide enhanced sensitivity and specificity compared with enzyme immunoassay and molecular testing respectively. Finally, the adoption of Matrix-Assisted Laser Desorption Ionization-Time of Flight Mass Spectrometry (MALDI TOF MS) for rapid organism identification is growing. Recent US Food and Drug Administration-clearance of a MALDI TOF MS platform for identification of Nocardia, Mycobacteria, and molds may expedite antimicrobial decisions for infections that traditionally required days to weeks for an identification. Summary Tests with broad diagnostic scope and swift turnaround time are rapidly entering the market. Many impact infection prevention and ASP programs. Collaboration with the microbiology laboratory is crucial to ensure that new tests successfully optimize patient care.

A multiplex polymerase chain reaction assay for antibiotic stewardship in suspected pneumonia

“…Rapid molecular techniques such as the Unyvero LRT Panel are a promising tool to help guide appropriate therapy and de-escalation from broad-spectrum antibiotic therapy in patients with suspected pneumonia. ( Torres et al, 2016 ; Sullivan and Dien Bard, 2019 ) However, like any new medical technology, their potential clinical impact requires testing in clinical practice, and data on multiplex assays in particular are lacking. Here we analyzed the potential impact on antibiotic use in patients with suspected pneumonia with implementation of the Unyvero LRT Panel using data from a non-interventional study that originally evaluated the operating characteristics of the assay.…”

Laboratory evaluation of the BioFire FilmArray Pneumonia plus panel compared to conventional methods for the identification of bacteria in lower respiratory tract specimens: a prospective cross-sectional study from South Africa

“…( Trotter et al, 2019 ) Rapid diagnostic technologies that detect antimicrobial resistance genes allow for timely implementation of infection prevention and control (IPC) measures. ( Sullivan and Bard, 2019 ) Consequently, rapid multiplex polymerase chain reaction (PCR) assays are fast becoming valuable diagnostic tools. ( Alby and Mitchell, 2018 ) A number of commercially available PCR assays have recently been approved for the diagnosis of pneumonia by the US Food and Drug Administration (US FDA, Washington, DC, USA).…”

Antimicrobial resistance in chronic liver disease

“…Newer technologies for determining antimicrobial susceptibility rapidly offer the potential to speed up the clinical administration of an appropriate antibiotic regimen and/or de-escalation, and will increasingly be key to the successful implementation of antimicrobial stewardship programmes [57][58][59]. These include (1) MALDI-TOF (matrix-assisted laser desorption/ionization time-of-flight) mass spectrometry [60], (2) automated combined bacterial (and fungal) identification within 90 min and antimicrobial susceptibility in approximately 7 h via Accelerate Pheno platform [61], and (3) nanotechnology partnered with microfluidics [62].…”