Schubert S, Wieser A, Bonkat G
Max von Pettenkofer-Institut für Hygiene und Medizinische Mikrobiologie, Ludwig-Maximilians-Universität München, Marchioninistr. 17, 81377, München, Deutschland.
Abteilung für Infektions- und Tropenmedizin der LMU, Leopoldstrasse 5, 80802, München, Deutschland.
Urologe A. 2017 Jun;56(6):711-719. doi: 10.1007/s00120-017-0395-3.
Microbiological diagnostic procedures have changed rapidly in recent years. This is especially true in the field of molecular diagnostics. Classical culture-based techniques are still the gold standard in many areas; however, they are already complemented by automated and also molecular techniques to guarantee faster and better quality results. The most commonly used techniques include real-time polymerase chain reaction (RT-PCR) based systems and nucleic acid hybridization. These procedures are used most powerfully from direct patient samples or in assays to detect the presence of nonculturable or fastidious organisms. Further techniques such as DNA sequencing are not yet used routinely for urological samples and can be considered experimental. However, in conjunction with dropping prices and further technical developments, these techniques promise to be used much more in the near future. Regarding bacterial identification from culture, mass spectrometry (MALDI-TOF MS) has become the technique of choice in recent years especially in Europe. It has tremendously shortened the time to result. This is now going to be extended to antibiotic susceptibility testing. This is of paramount importance in view of ever rising antimicrobial resistance rates. Techniques described in this review offer a faster and better microbiological diagnosis. Such continuous improvements are critical especially in times of cost pressure and rising antimicrobial resistance rates. It is in our interest to provide the best possible care for patients and in this regard a good and effective communication between the laboratory and the clinician is of vital importance.
近年来，微生物诊断程序变化迅速。在分子诊断领域尤其如此。传统的基于培养的技术在许多领域仍然是金标准；然而，它们已经被自动化技术以及分子技术所补充，以确保获得更快、质量更好的结果。最常用的技术包括基于实时聚合酶链反应（RT-PCR）的系统和核酸杂交。这些程序在直接从患者样本或检测不可培养或苛求菌的检测中使用得最为有效。诸如DNA测序等进一步的技术尚未常规用于泌尿系统样本，可被视为实验性技术。然而，随着价格下降和技术进一步发展，这些技术有望在不久的将来得到更多应用。关于从培养物中鉴定细菌，近年来质谱分析（MALDI-TOF MS）已成为首选技术，尤其是在欧洲。它极大地缩短了出结果的时间。现在这将扩展到抗生素敏感性测试。鉴于抗菌药物耐药率不断上升，这至关重要。本综述中描述的技术提供了更快、更好的微生物诊断。在面临成本压力和抗菌药物耐药率上升的时代，这种持续改进至关重要。为患者提供尽可能好的护理符合我们的利益，在这方面，实验室与临床医生之间良好而有效的沟通至关重要。
