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A Paradigm Shift in Clinical Microbiology

Over the last decade, advances in molecular diagnostics tools like PCR testing have become the new standard for identifying infectious agents. PCR uses small DNA fragments that are amplified through temperature changes. However, the cost and limited coverage of pathogens hinders more widespread PCR use clinically. While culture is the gold standard for CSF diagnosis, low bacterial growth rates, especially in pre-treated patients, necessitated new tests. PCR can detect small amounts of pathogen DNA independent of growth, and identify the cause of UTI within hours. Combining PCR and culture may improve clinical sensitivity and selectivity by leveraging their individual strengths and weaknesses.

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Norina Asfand
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54 views1 page

A Paradigm Shift in Clinical Microbiology

Over the last decade, advances in molecular diagnostics tools like PCR testing have become the new standard for identifying infectious agents. PCR uses small DNA fragments that are amplified through temperature changes. However, the cost and limited coverage of pathogens hinders more widespread PCR use clinically. While culture is the gold standard for CSF diagnosis, low bacterial growth rates, especially in pre-treated patients, necessitated new tests. PCR can detect small amounts of pathogen DNA independent of growth, and identify the cause of UTI within hours. Combining PCR and culture may improve clinical sensitivity and selectivity by leveraging their individual strengths and weaknesses.

Uploaded by

Norina Asfand
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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A paradigm shift in Clinical Microbiology

Over the last decade, several significant advances are made in clinical microbiology. With the
advances in molecular diagnostics tools, the use of PCR testing has become the new standard of
testing for the identification of infectious agents. In this technique, small fragments of DNA are
used which are amplified and replicated by the process at different temperatures. However, the
cost and lack of comprehensive coverage of infectious agent hinder the more widespread use of
PCR in the clinical arena. On the other side, the CSF culture is the gold standard in the diagnosis,
the low bacterial growth rates, particularly in the patients who have received antibiotic treatment
before the lumbar puncture (LP), necessitated the development of new test methods. Also, results
may not be available for days or weeks, and not all pathogens can be cultured Nucleic acid
amplification tests such as the PCR can detect small amounts of pathogen DNA independently
from the growth of the microorganism causing the disease.

Recently, the use of PCR testing in the detection and identification of Urinary Tract Infection
(UTI) and Wound Infection is gaining interest in clinical diagnosis. This new multiplex real-time
PCR test for the detection of 25 common bloodstream pathogens works. Several recent
retrospective studies compare the ability of conventional cultures and PCR in clinical
microbiology. The greater sensitivity and selectivity of PCR compared with traditional culture
for identification of infection does make PCR superior technology. Molecular based diagnosis
has the advantage that it can identify the cause of UTI within hours. Real-time PCR is
increasingly used to diagnose systemic blood infections or genital infections. Several clinical
comparative studies have shown a higher rate of identification of infection in symptomatic
patients. The major advantages lie in the detection of the pathogen which is hard to grow in the
lab or completely uncultivated. PCR is theoretically able to identify bacteria despite treatment
with antibiotic therapy. PCR may quickly detect bacterial species during the first debridement in
OR while cultures may help evaluate wound biodiversity with serial debridement and detection
of co-infection play a major role in pushing the use of PCR over traditional culture. But one
major shortcoming with the use of PCR is the lack of drug sensitivity information. However,
PCR does provide information on markers of drug resistance gene which can help in drug
selection based on elimination strategy. Although both technologies have their own
shortcomings, can we combine both to improve clinical sensitivity and selectivity?

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