Molecular diagnosis of bloodstream infections: planning to (physically) reach the bedside.
OBJECTIVE
Faster identification of infecting microorganisms and treatment options is a first-ranking priority in the infectious disease area, in order to prevent inappropriate treatment and overuse of broad-spectrum antibiotics. Standard bacterial identification is intrinsically time-consuming, and very recently there has been a burst in the number of commercially available nonphenotype-based techniques and in the documentation of a possible clinical impact of these techniques.


RESULTS
Matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF MS) is now a standard diagnostic procedure on cultures and hold promises on spiked blood. Meanwhile, commercial PCR-based techniques have improved with the use of bacterial DNA enrichment methods, the diversity of amplicon analysis techniques (melting curve analysis, microarrays, gel electrophoresis, sequencing and analysis by mass spectrometry) leading to the ability to challenge bacterial culture as the gold standard for providing earlier diagnosis with a better 'clinical' sensitivity and additional prognostic information.


CONCLUSIONS
Laboratory practice has already changed with MALDI-TOF MS, but a change in clinical practice, driven by emergent nucleic acid-based techniques, will need the demonstration of real-life applicability as well as robust clinical-impact-oriented studies.
Leggieri
N
N
Bacteriology Laboratory, Service of Infectious Diseases, University of Geneva Hospitals, Rue Gabrielle-Perret-Gentil, Geneva, Switzerland.
Rida
A
A
François
P
P
Schrenzel
Jacques
J
D016470:Bacteremia / Q000175:diagnosis* / Q000382:microbiology; D015373:Bacterial Typing Techniques / Q000379:methods / Q000639:trends; D004269:DNA, Bacterial; D006801:Humans; D008826:Microbial Sensitivity Tests; D025202:Molecular Diagnostic Techniques / Q000379:methods / Q000639:trends; D019095:Point-of-Care Systems; D016133:Polymerase Chain Reaction; D013997:Time Factors
D004269:DNA, Bacterial