The impact of molecular diagnostics on antimicrobial stewardship and infection control

Fred C. Tenover1

1 Cepheid, Sunnyvale, CA 94089 USA; fred.tenover@cepheid.com

 

Nucleic acid amplification methods can provide data on the presence of bacterial, fungal, viral, and parasitic pathogens, in addition to antimicrobial resistance genes directly from clinical specimens, often in less than 1 hour. Bacteria causing sepsis, respiratory tract infections (including tuberculosis), and wound infections (such as Staphylococcus aureus) are all amenable to rapid detection and reporting. Data from several studies demonstrate improved patient outcomes and overall cost effectiveness of using molecular methods for optimizing therapy early in the course of disease.  However, the issue of whether molecular methods are too sensitive for detection of Clostridium difficile has been suggested.  Similarly, the value of universal or targeted surveillance for methicillin-resistant Staphylococcus aureus versus blanket decolonization of all patients to decrease staphylococcal infections is under discussion. The key question is, can a laboratory method be too sensitive for infection control surveillance? The potential value for monitoring the spread of carbapenemase-producing organisms in healthcare settings is now being explored. Implementation of molecular assays often requires education programs for physicians to assist them in understanding how to use the molecular data to optimize antibiotic treatment regimens and infection prevention programs.  It is likely that molecular assays will have a substantial impact on addressing the critical issue of antimicrobial resistance.

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