title: Emerging rapid resistance testing methods for clinical microbiology laboratories and their potential impact on patient management.
abstract: Atypical and multidrug resistance, especially ESBL and carbapenemase expressing Enterobacteriaceae, is globally spreading. Therefore, it becomes increasingly difficult to achieve therapeutic success by calculated antibiotic therapy. Consequently, rapid antibiotic resistance testing is essential. Various molecular and mass spectrometry-based approaches have been introduced in diagnostic microbiology to speed up the providing of reliable resistance data. PCR- and sequencing-based approaches are the most expensive but the most frequently applied modes of testing, suitable for the detection of resistance genes even from primary material. Next generation sequencing, based either on assessment of allelic single nucleotide polymorphisms or on the detection of nonubiquitous resistance mechanisms might allow for sequence-based bacterial resistance testing comparable to viral resistance testing on the long term. Fluorescence in situ hybridization (FISH), based on specific binding of fluorescence-labeled oligonucleotide probes, provides a less expensive molecular bridging technique. It is particularly useful for detection of resistance mechanisms based on mutations in ribosomal RNA. Approaches based on MALDI-TOF-MS, alone or in combination with molecular techniques, like PCR/electrospray ionization MS or minisequencing provide the fastest resistance results from pure colonies or even primary samples with a growing number of protocols. This review details the various approaches of rapid resistance testing, their pros and cons, and their potential use for the diagnostic laboratory.
authors.affiliation: Fachbereich Tropenmedizin am Bernhard-Nocht-Institut, Bundeswehrkrankenhaus Hamburg, 20359 Hamburg, Germany ; Institut für Medizinische Mikrobiologie, Virologie und Hygiene, Universitätsmedizin Rostock, 18057 Rostock, Germany.
authors.forename: Hagen
authors.initials: H
authors.lastname: Frickmann
authors.affiliation: UMG-Labor, Abteilung Klinische Chemie/Zentrallabor, Universitätsmedizin Göttingen, 37075 Göttingen, Germany ; Institut für Medizinische Mikrobiologie, Universitätsmedizin Göttingen, Kreuzbergring 57, 37075 Göttingen, Germany.
authors.forename: Wycliffe Omurwa
authors.identifier: 0000-0003-4194-9055
authors.initials: WO
authors.lastname: Masanta
authors.affiliation: UMG-Labor, Abteilung Klinische Chemie/Zentrallabor, Universitätsmedizin Göttingen, 37075 Göttingen, Germany ; Institut für Medizinische Mikrobiologie, Universitätsmedizin Göttingen, Kreuzbergring 57, 37075 Göttingen, Germany.
authors.forename: Andreas E
authors.initials: AE
authors.lastname: Zautner
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D001431:Bacteriological Techniques / Q000639:trends*; D019411:Clinical Laboratory Techniques / Q000639:trends*; D024881:Drug Resistance, Bacterial / Q000187:drug effects* / Q000502:physiology*; D005544:Forecasting
chemical_list: D000900:Anti-Bacterial Agents