University of Groningen, University Medical Center Groningen, Department of Medical Microbiology, Groningen, The Netherlands.
University of Groningen, University Medical Center Groningen, Department of Medical Microbiology, Groningen, The Netherlands.
Clin Microbiol Infect. 2018 Sep;24(9):944-955. doi: 10.1016/j.cmi.2018.05.007. Epub 2018 May 19.
Bloodstream infections are a major cause of death with increasing incidence and severity. Blood cultures are still the reference standard for microbiological diagnosis, but are rather slow. Molecular methods can be used as add-on complementary assays. They can be useful to speed up microbial identification and to predict antimicrobial susceptibility, applied to direct blood samples or positive blood cultures.
To review recent developments in molecular-based diagnostic platforms used for the identification of bloodstream infections, with a focus on assays performed directly on blood samples and positive blood cultures.
Peer reviewed articles, conference abstracts, and manufacturers' websites.
We give an update on recent developments of molecular methods in diagnosing BSIs. We first describe the currently available molecular methods to be used for positive blood cultures including: a) in situ hybridization-based methods; b) DNA-microarray-based hybridization technology; c) nucleic acid amplification-based methods; and d) combined methods. Subsequently, molecular methods applied directly to whole blood samples are discussed, including the use of nucleic acid amplification-based methods, T2 magnetic resonance-based methods, and metagenomics for diagnosing BSIs.
Advances in molecular-based methods complementary to conventional blood culture diagnostics and antimicrobial stewardship programmes may optimize infection management by allowing rapid identification of pathogens and relevant antimicrobial resistance genes. Rapid diagnosis of the causing microorganism and relevant resistance determinants is important for early administration and modification of appropriate antimicrobial therapy. Ultimately, this may lead to improved quality and cost-effectiveness of health care, as well as reduced antimicrobial resistance selection.
血流感染是导致死亡的主要原因，其发病率和严重程度呈上升趋势。血培养仍然是微生物诊断的参考标准，但速度较慢。分子方法可用作附加的补充检测。它们可以用于加速微生物鉴定，并预测抗菌药物敏感性，应用于直接血样或阳性血培养物。
回顾用于血流感染鉴定的基于分子的诊断平台的最新进展，重点是直接在血样和阳性血培养物上进行的检测。
同行评议的文章、会议摘要和制造商的网站。
我们介绍了诊断血流感染的分子方法的最新进展。我们首先描述了目前可用于阳性血培养的分子方法，包括：a）基于原位杂交的方法；b）基于 DNA 微阵列的杂交技术；c）基于核酸扩增的方法；和 d）联合方法。随后，讨论了直接应用于全血样本的分子方法，包括基于核酸扩增的方法、T2 磁共振方法和宏基因组学在诊断血流感染中的应用。
补充传统血培养诊断和抗菌药物管理计划的基于分子的方法的进步，可通过允许快速鉴定病原体和相关的抗菌药物耐药基因，优化感染管理。快速诊断致病微生物和相关耐药决定因素对于早期给予和调整适当的抗菌治疗非常重要。最终，这可能会提高医疗保健的质量和成本效益，并减少抗菌药物耐药性的选择。
