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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/cdn\/css\/http\/css_Xg7z6oCTVgud_Q0huYz9x9iiD5H_2YPSJ5z2ZViSWdY.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\u003Cp id=\u0022p-1\u0022\u003EDetection and identification of bacterial, viral, and parasitic pathogens that are both rapid and accurate are important in curbing infections. The days-long growth-based detection and identification procedures have been reduced to hours and even minutes. Nuclear detection techniques and detection of real-time nanoscale changes in susceptible bacteria hold promise.\u003C\/p\u003E\u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003Eantibacterial\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Eautomation\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Esusceptibility\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Especificity\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Eantibiotics\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Eresistance\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Ebacterial infections\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Efungal infections\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Elaboratory techniques\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Einfectious diseases screening \u0026amp; prevention\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Eviral infections\u003C\/li\u003E\u003C\/ul\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\u003Cp id=\u0022p-2\u0022\u003EThe traditional culture-based detection of bacteria has been bolstered by microscopy-, molecular, and antigen-based detection techniques, according to Arjana T. Andrasevic, MD, University Hospital for Infectious Diseases, Zagreb, Croatia.\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EAutomated point-of-care testing of swab or blood samples relies on detection of pathogen-specific antigens and sequences of genetic material. Results are available within hours and can guide treatment [Little P et al. \u003Cem\u003EBMJ\u003C\/em\u003E. 2013; Maltezou HC et al. \u003Cem\u003EJ Antimicrob Chemother\u003C\/em\u003E. 2008]. Such testing could conceivably expand to locales including local pharmacies.\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EPolymerase chain reaction (PCR)\u2013based rapid diagnostics can detect bacterial and viral respiratory infection, which can progress rapidly and which remains one of the leading causes of morbidity and mortality worldwide (\u003Ca id=\u0022xref-table-wrap-1-1\u0022 class=\u0022xref-table\u0022 href=\u0022#T1\u0022\u003ETable 1\u003C\/a\u003E).\u003C\/p\u003E\u003Cdiv id=\u0022T1\u0022 class=\u0022table pos-float\u0022\u003E\u003Cdiv class=\u0022table-inline\u0022\u003E\u003Cdiv class=\u0022callout\u0022\u003E\u003Cspan\u003EView this table:\u003C\/span\u003E\u003Cul class=\u0022callout-links\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022\/\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/16625\/expansion?postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0026amp;table-expand-inline=1\u0022 html=\u00221\u0022 fragment=\u0022#\u0022 external=\u00221\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022\/highwire\/markup\/16625\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/16625\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv class=\u0022table-caption\u0022\u003E\u003Cspan class=\u0022table-label\u0022\u003ETable 1.\u003C\/span\u003E \u003Cp id=\u0022p-5\u0022 class=\u0022first-child\u0022\u003EExamples of Rapid Diagnostics for Respiratory Infections\u003C\/p\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-9\u0022\u003EPCR testing is widely used for the diagnosis of tuberculosis, gastrointestinal infections, urogenital infections, and bacteremia. Detection is sensitive: it identifies the causal pathogen with a fidelity approaching 100%. The speed and accuracy of PCR testing have been exploited in hospital infection control programs that aim to minimize the spread of bacterial pathogens.\u003C\/p\u003E\u003Cp id=\u0022p-10\u0022\u003EOther rapid diagnostic techniques, such as fluorescence in situ hybridization and matrix-assisted laser desorption ionization\u2013time of flight (MALDI-TOF), remain more in the research realm. Whole genome sequencing holds the potential of detecting resistance-associated genes and genetic determinants of infection. Further refinements may allow sequence-based point-of-care testing.\u003C\/p\u003E\u003Cp id=\u0022p-11\u0022\u003ERapid diagnostics have potential value in the diagnosis of malaria and other parasitic infections, according to Sanjeev Krishna, ScD, St George\u2019s University, London, United Kingdom. Malaria causes 500 million infections resulting in \u0026gt;\u20051 million deaths each year. Microscopy identification is ponderous and time-consuming. DNA-based speciation of \u003Cem\u003EPlasmodium\u003C\/em\u003E is rudimentary. Refinements in PCR identification and development of rapid, accurate, and portable diagnostic tests are needed.\u003C\/p\u003E\u003Cp id=\u0022p-12\u0022\u003ESeveral resistance-associated malaria gene mutations have been identified, and a prototype apparatus capable of detecting these mutations has been developed. Efforts to economize testing are ongoing, with the goal of real-time surveillance at sites of malaria outbreaks and in the screening of travelers returning from malaria-endemic regions.\u003C\/p\u003E\u003Cp id=\u0022p-13\u0022\u003EAs described by Jesse Papenburg, MD, MSc, Montreal Children\u2019s Hospital, Montr\u00e9al, Quebec, Canada, accurate automated viral diagnostic testing that is easier to do and faster than the traditional approaches is under development or already in place, particularly for acute infections caused by respiratory syncytial virus (RSV) and influenza virus.\u003C\/p\u003E\u003Cp id=\u0022p-14\u0022\u003EThe goal is to have test results available during the clinician\u2019s examination of the patient. The benefits of rapid diagnosis include delivery of care during hospitalization, patient management following discharge, and the availability of testing at home and in the community [Pai NP et al. \u003Cem\u003EPLoS Med\u003C\/em\u003E. 2012; Staub LP et al. \u003Cem\u003EInt J Health Tech Assess\u003C\/em\u003E. 2012].\u003C\/p\u003E\u003Cp id=\u0022p-15\u0022\u003EThe majority of respiratory infections in hospitalized children are viral [Papenburg J et al. \u003Cem\u003EJ Infect Dis\u003C\/em\u003E. 2012]. Being able to rapidly identify these infections lessens the inappropriate and futile use of antibiotics and decreases ancillary testing. Rapid diagnosis helps guide antiviral therapy for influenza and improves infection control.\u003C\/p\u003E\u003Cp id=\u0022p-16\u0022\u003ERapid antigen detection tests (RADTs) for RSV are widely used in clinical laboratories and are licensed for point-of-care use. With this technique, RSV antibody specifically binds to surface-immobilized antigen and is visualized [Prendergast C, Papenburg J. \u003Cem\u003EFuture Microbiol\u003C\/em\u003E. 2013]. The test is not perfect; an as-yet-unpublished meta-analysis of RSV RADT evaluations revealed a low sensitivity in adults (29%; 95% CI, 11% to 48%). False-negative results are more prevalent in older hospitalized children, those with symptom duration exceeding 5 days, and those infected with the RSV-B genotype [Papenburg J et al. \u003Cem\u003EJ Pediatr\u003C\/em\u003E. 2013]. RADTs for influenza have room for improvement, with a reported overall sensitivity of 62.3% (95% CI, 57.9% to 66.6%), with even lower sensitivity in adults and those infected with influenza B, A\/H1N1\/2009, H3N2v, H7N9, and H5N1 [Chartrand C et al. \u003Cem\u003EAnn Intern Med\u003C\/em\u003E. 2012]. For both viral respiratory infections, negative RADT results are not reliable. Follow-up PCR testing may be indicated, which delays diagnosis and adds to the health care cost.\u003C\/p\u003E\u003Cp id=\u0022p-17\u0022\u003ENew-generation influenza RADTs that detect viral nucleoprotein have been developed. They feature improved detection sensitivity, high specificity, and an analytic time of about 15 minutes.\u003C\/p\u003E\u003Cp id=\u0022p-18\u0022\u003ENucleic acid amplification tests feature sensitivities and specificities \u0026gt;\u200590% and \u0026gt;\u200597%, respectively. Some may be almost as rapid and as easy to do as RADTs and, because of their closed system design, lessen the risk of contamination. Commercial tests capable of detecting the target virus in a 1-step process are on the clinical horizon (\u003Ca id=\u0022xref-table-wrap-2-1\u0022 class=\u0022xref-table\u0022 href=\u0022#T2\u0022\u003ETable 2\u003C\/a\u003E).\u003C\/p\u003E\u003Cdiv id=\u0022T2\u0022 class=\u0022table pos-float\u0022\u003E\u003Cdiv class=\u0022table-inline\u0022\u003E\u003Cdiv class=\u0022callout\u0022\u003E\u003Cspan\u003EView this table:\u003C\/span\u003E\u003Cul class=\u0022callout-links\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022\/\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/16626\/expansion?postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0026amp;table-expand-inline=1\u0022 html=\u00221\u0022 fragment=\u0022#\u0022 external=\u00221\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022\/highwire\/markup\/16626\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/16626\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv class=\u0022table-caption\u0022\u003E\u003Cspan class=\u0022table-label\u0022\u003ETable 2.\u003C\/span\u003E \u003Cp id=\u0022p-19\u0022 class=\u0022first-child\u0022\u003EOne-Step, Rapid, Commercially Developed Nucleic Acid Amplification Tests\u003C\/p\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-26\u0022\u003EAs discussed by Alex van Belkum, PhD, bioM\u00e9rieux, La Balme les Grottes, France, rapid testing is moving toward antimicrobial susceptibility testing on a phenotype-specific basis. This aspect of automated rapid technology remains rooted in culture-based methods (hands-on and automated) and antibiotic broth and disc diffusion assays, which are still valuable in selection of resistance phenotypes. Rapid automation of these tried-and-true approaches has merit. These traditional approaches have been bolstered by the development of PCR techniques, MALDI-TOF, specialized microscopy methods, microarrays, and color-dependent assays of bacterial viability. Still, ever-increasing bacterial resistance and a shortening list of available effective drugs make the need for rapid identification and testing of candidate antibacterial compounds urgent [Pulido MR et al. \u003Cem\u003EJ Antimicrob Chemother\u003C\/em\u003E. 2013]. In this changing landscape, standardized guidelines of test certification and interpretation are important.\u003C\/p\u003E\u003Cp id=\u0022p-27\u0022\u003EA plethora of technologies offers potential value in rapid automated susceptibility testing, according to Prof van Belkum, which include but are not limited to the following:\u003C\/p\u003E\u003Cul class=\u0022list-unord \u0022 id=\u0022list-1\u0022\u003E\u003Cli id=\u0022list-item-1\u0022\u003E\u003Cp id=\u0022p-28\u0022\u003EFlow cytometry\u003C\/p\u003E\u003C\/li\u003E\u003Cli id=\u0022list-item-2\u0022\u003E\u003Cp id=\u0022p-29\u0022\u003EIsothermal microcalorimetrics\u003C\/p\u003E\u003C\/li\u003E\u003Cli id=\u0022list-item-3\u0022\u003E\u003Cp id=\u0022p-30\u0022\u003EMicrosound\u003C\/p\u003E\u003C\/li\u003E\u003Cli id=\u0022list-item-4\u0022\u003E\u003Cp id=\u0022p-31\u0022\u003ENext-generation mass spectrometry\u003C\/p\u003E\u003C\/li\u003E\u003Cli id=\u0022list-item-5\u0022\u003E\u003Cp id=\u0022p-32\u0022\u003EReal-time video-enhanced microscopy\u003C\/p\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-33\u0022\u003EFor example, combining fluorescence live\/dead microscopic examination or absorbance-based (cell density) examination with multiwell growth-based assays could be exploited to screen for antibacterial compounds.\u003C\/p\u003E\u003Cp id=\u0022p-34\u0022\u003EFor the future, MALDI-TOF is being explored as a means of detecting antibiotic degradation or modification [Jung J et al. \u003Cem\u003EEur J Clin Microbiol Infect Dis\u003C\/em\u003E. 2014]. Next-generation mass spectrometry may enable detection of bacterial vibrations on the nanoscale, allowing detection of viability that cannot be otherwise detected [Kasas S et al. \u003Cem\u003EProc Natl Acad Sci U S A\u003C\/em\u003E. 2015]. The use of quartz crystal microbalance and electrochemical sensing has potential in detecting surface changes of bacteria associated with lysis [Ma F et al. \u003Cem\u003EAnal Chem\u003C\/em\u003E. 2015].\u003C\/p\u003E\u003Cp id=\u0022p-35\u0022\u003EThese and other molecular-level techniques [Barczak AK et al. \u003Cem\u003EProc Natl Acad Sci U S A\u003C\/em\u003E. 2012] offer hope for rapid determination of antibacterial susceptibility. Issues of concern include compatibility of the next-generation approaches in the workflow of the typical laboratory, potential barriers to complete automation, certification of techniques, purchase cost, and handling\/disposal of test materials.\u003C\/p\u003E\u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2015 SAGE Publications\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/15\/48\/25.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzlme2\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_tables.js?nzlme2\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}