Fisher Mark
West London Bio Tech Hub, Royal Brompton & Harefield NHS Trust, Royal Brompton Hospital, Sydney Street, London SW3 6NP, UK.
Expert Rev Mol Diagn. 2002 Mar;2(2):151-9. doi: 10.1586/14737159.2.2.151.
The resurgence of tuberculosis worldwide has been accompanied by an increase in the incidence of multidrug-resistant tuberculosis on all continents. While significant advances have been made in the rapid and accurate diagnosis of Mycobacterium tuberculosis, the molecular biology methods used in the research laboratory to elucidate the mechanisms of drug resistance cannot be transferred to the centers delivering patient care. These methods require skilled operators, cumbersome protocols and extravagant expense. A number of companies that already have a large investment in M. tuberculosis diagnostics are adapting their high-throughput technology to drug susceptibility testing. These methodologies are not applicable to the developing world not only because of the costs involved but through a lack of infrastructure that is required to operate these machines and deliver specimens to the point of testing. Alternative technologies for drug susceptibility testing that do not rely on an investment in expensive hardware are presented and their potential use in the field is discussed. Though still relatively expensive to perform, these newer innovations may lead to the development of less intricate technologies that have universal application and begin to move away from our obsession with molecular-based diagnostics to produce on all encompassing gold standard.
全球结核病的死灰复燃伴随着各大洲耐多药结核病发病率的上升。虽然在结核分枝杆菌的快速准确诊断方面已取得重大进展，但研究实验室用于阐明耐药机制的分子生物学方法无法应用于提供患者护理的中心。这些方法需要技术熟练的操作人员、繁琐的方案和高昂的费用。一些已经在结核分枝杆菌诊断方面投入大量资金的公司正在将其高通量技术应用于药敏试验。这些方法不仅因为成本问题不适用于发展中世界，还因为缺乏操作这些机器和将标本送到检测点所需的基础设施。本文介绍了不依赖昂贵硬件投资的药敏试验替代技术，并讨论了它们在该领域的潜在用途。尽管这些新技术的操作成本仍然相对较高，但它们可能会促使开发出更简单的技术，这些技术具有普遍适用性，并使我们逐渐摆脱对基于分子诊断的痴迷，从而产生一个全面的金标准。
