Woodford Neil, Sundsfjord Arnfinn
Antibiotic Resistance Monitoring and Reference Laboratory, Centre for Infections, Health Protection Agency, 61 Colindale Avenue, London NW9 5HT, UK.
J Antimicrob Chemother. 2005 Aug;56(2):259-61. doi: 10.1093/jac/dki195. Epub 2005 Jun 20.
Antibiotic resistance is a key issue affecting public health, and diagnostic bacteriology laboratories are essential for prompt recognition of resistant isolates. Determination of susceptibility or resistance using phenotypic tests is a 'gold standard' against which newer technologies are compared in terms of performance, cost and ease of use. Molecular methods for detecting resistance are myriad, and are used widely in academia and in reference laboratories, but gaining a significant foothold in diagnostic laboratories is proving more difficult. However, if used widely in a diagnostic setting, these techniques would impact more directly on patient care and would be valuable infection control tools, e.g. by rapidly confirming patients colonized by resistant bacteria. The cost of molecular assays may be considered prohibitive, and this is compounded by the daunting variety of proprietary platforms available; most diagnostic laboratories would prefer to invest their capital and to train their staff in a single versatile technology. In a market that has no clear leader, many laboratories are understandably reluctant to gamble on making the correct choice. If molecular detection of resistance is to achieve wide acceptance, manufacturers must broaden the repertoires of their technologies, develop more off-the-shelf applications with in-built quality control, and make them suitable for laboratory personnel with no specialist expertise in molecular biology.
抗生素耐药性是影响公众健康的关键问题，诊断细菌学实验室对于及时识别耐药菌株至关重要。使用表型试验确定敏感性或耐药性是一种“金标准”，新的技术会在性能、成本和易用性方面与之进行比较。检测耐药性的分子方法多种多样，在学术界和参考实验室中广泛使用，但在诊断实验室中获得显著地位却更加困难。然而，如果在诊断环境中广泛使用，这些技术将更直接地影响患者护理，并且将成为有价值的感染控制工具，例如通过快速确认被耐药菌定植的患者。分子检测的成本可能被认为过高，并且可用的专有平台种类繁多令人望而却步，这使情况更加复杂；大多数诊断实验室更愿意将资金投入并培训员工掌握单一通用技术。在一个没有明显领先者的市场中，许多实验室不愿冒险做出正确选择是可以理解的。如果耐药性的分子检测要获得广泛认可，制造商必须拓宽其技术范围，开发更多具有内置质量控制的现成应用，并使其适用于没有分子生物学专业知识的实验室人员。
