Tjandra Kristel C, Ram-Mohan Nikhil, Abe Ryuichiro, Hashemi Marjan M, Lee Jyong-Huei, Chin Siew Mei, Roshardt Manuel A, Liao Joseph C, Wong Pak Kin, Yang Samuel
Department of Emergency Medicine, Stanford University School of Medicine, Palo Alto, CA 94305, USA.
Department of Biomedical Engineering, The Pennsylvania State University, University Park, PA 16802, USA.
Antibiotics (Basel). 2022 Apr 12;11(4):511. doi: 10.3390/antibiotics11040511.
Bloodstream infections (BSI) are a leading cause of death worldwide. The lack of timely and reliable diagnostic practices is an ongoing issue for managing BSI. The current gold standard blood culture practice for pathogen identification and antibiotic susceptibility testing is time-consuming. Delayed diagnosis warrants the use of empirical antibiotics, which could lead to poor patient outcomes, and risks the development of antibiotic resistance. Hence, novel techniques that could offer accurate and timely diagnosis and susceptibility testing are urgently needed. This review focuses on BSI and highlights both the progress and shortcomings of its current diagnosis. We surveyed clinical workflows that employ recently approved technologies and showed that, while offering improved sensitivity and selectivity, these techniques are still unable to deliver a timely result. We then discuss a number of emerging technologies that have the potential to shorten the overall turnaround time of BSI diagnosis through direct testing from whole blood-while maintaining, if not improving-the current assay's sensitivity and pathogen coverage. We concluded by providing our assessment of potential future directions for accelerating BSI pathogen identification and the antibiotic susceptibility test. While engineering solutions have enabled faster assay turnaround, further progress is still needed to supplant blood culture practice and guide appropriate antibiotic administration for BSI patients.
血流感染（BSI）是全球主要的死亡原因之一。缺乏及时可靠的诊断方法是管理血流感染的一个长期问题。目前用于病原体鉴定和抗生素敏感性测试的金标准血培养方法耗时较长。延迟诊断需要使用经验性抗生素，这可能导致患者预后不良，并存在抗生素耐药性发展的风险。因此，迫切需要能够提供准确及时诊断和敏感性测试的新技术。本综述聚焦于血流感染，突出了其当前诊断方法的进展和不足。我们调查了采用近期获批技术的临床工作流程，结果表明，尽管这些技术提高了敏感性和选择性，但仍无法及时给出诊断结果。然后，我们讨论了一些新兴技术，这些技术有可能通过对全血进行直接检测来缩短血流感染诊断的整体周转时间，同时保持（如果不是提高的话）当前检测方法的敏感性和病原体覆盖范围。最后，我们对加速血流感染病原体鉴定和抗生素敏感性测试的潜在未来方向进行了评估。虽然工程解决方案已使检测周转更快，但仍需进一步进展以取代血培养方法，并指导为血流感染患者合理使用抗生素。
