title: A biosensor platform for rapid antimicrobial susceptibility testing directly from clinical samples.
abstract: OBJECTIVE
  A significant barrier to efficient antibiotic management of infection is that the standard diagnostic methodologies do not provide results at the point of care. The delays between sample collection and bacterial culture and antibiotic susceptibility reporting have led to empirical use of antibiotics, contributing to the emergence of drug resistant pathogens. As a key step toward the development of a point of care device for determining the antibiotic susceptibility of urinary tract pathogens, we report on a biosensor based antimicrobial susceptibility test.
  
  
  METHODS
  For assay development bacteria were cultured with or without antibiotics, and growth was quantitated by determining viable counts and electrochemical biosensor measurement of bacterial 16S rRNA. To determine antibiotic susceptibility directly from patient samples, urine was cultured on antibiotic plates for 2.5 hours and growth was determined by electrochemical measurement of bacterial 16S rRNA. For assay validation 252 urine samples were collected from patients at the Spinal Cord Injury Service at Veterans Affairs Palo Alto Health Care System. The biosensor based antimicrobial susceptibility test was completed for samples containing gram-negative organisms. Pathogen identification and antibiotic susceptibility results were compared between our assay and standard microbiological analysis.
  
  
  RESULTS
  A direct biosensor quantitation of bacterial 16S rRNA can be used to monitor bacterial growth for a biosensor based antimicrobial susceptibility test. Clinical validation of a biosensor based antimicrobial susceptibility test with patient urine samples demonstrated that this test was 94% accurate in 368 pathogen-antibiotic tests compared to standard microbiological analysis.
  
  
  CONCLUSIONS
  This biosensor based antimicrobial susceptibility test, in concert with our previously described pathogen identification assay, can provide culture and susceptibility information directly from a urine sample within 3.5 hours.
authors.affiliation: Department of Urology, Stanford University School of Medicine, Stanford, California, USA.
authors.forename: Kathleen E
authors.initials: KE
authors.lastname: Mach
authors.forename: Ruchika
authors.initials: R
authors.lastname: Mohan
authors.forename: Ellen Jo
authors.initials: EJ
authors.lastname: Baron
authors.forename: Mei-Chiung
authors.initials: MC
authors.lastname: Shih
authors.forename: Vincent
authors.initials: V
authors.lastname: Gau
authors.forename: Pak Kin
authors.initials: PK
authors.lastname: Wong
authors.forename: Joseph C
authors.initials: JC
authors.lastname: Liao
mesh_terms: D001419:Bacteria / Q000187:drug effects; D015374:Biosensing Techniques; D006801:Humans; D008826:Microbial Sensitivity Tests / Q000379:methods*; D013997:Time Factors; D014552:Urinary Tract Infections / Q000382:microbiology