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A paradigm shift from the bench to the bedside

Globally, there is an exponential rise in antimicrobial-resistant infections. The diagnosis of emerging and reemerging infections is a constant challenge faced by microbiology laboratories. In this context, it is very important for clinical microbiology laboratories to evolve and adapt using most current and advanced technology for rapid and accurate results.

Traditionally, the microbiology laboratory has relied upon conventional methods such as culture, biochemical identification, and susceptibility by disk diffusion. Recent progress in the fields of equipment, reagents, and techniques has focused on automating most of the manual processes involved in the microbiology laboratory.

Microbial identification (ID) and antibiotic-susceptibility testing (AST) are central to providing the right information for targeted clinical management and antimicrobial stewardship. The newer automated technology combines phenotypic identification with an expansive database and intelligent software delivering faster and accurate identification and susceptibility results. Using the standardized technology, it is possible for the laboratory to not only provide faster antibiotic susceptibility results but also minimum inhibitory concentration values (MIC) which can be used by clinicians to deliver targeted therapy and in turn better patient management. It is hence possible to perform more number of tests in a short time, alongwith a decrease in technical complexity and errors. Introduction of novel techniques, such as mass spectrometry has revolutionized the time taken for accurate microbial identification, reducing it to minutes. Further applications such as identification of drug resistance markers are being increasingly incorporated into the mainstream applications.

Direct identification of microorganisms is crucial to the diagnosis of infectious diseases. There is a plethora of microbes that cannot be grown in culture or need extended incubation time leading to a delay in diagnosis. Rapid diagnostic methods such as immunochromatography detect antigens or antibodies and are important screening tools. Molecular microbiology techniques, such as real-time PCR, multiplex PCR, sequencing and next-generation sequencing are an integral part of a diagnostic microbiology setup. Molecular microbiology has a crucial role to play in critical scenarios such as sepsis, endocarditis, hospital-associated infections, and intensive care, not only in the diagnosis of infectious diseases but also for monitoring during therapy and epidemiologic surveillance.

From a buyer’s perspective, the focus with respect to equipment and technology is on quality and automation. Robust equipment with smaller footprint and a user-friendly interface is preferred. In an accreditation scenario, it is very important that the technology and tests therein be FDA or equivalent approved.

With limited insurance coverage and a large self-paying patient population, costs of the diagnostic tests are a major hurdle. As more and more laboratories adapt newer technology, it is expected that the costs of reagents and equipment become increasingly affordable. Public private partnerships can also help in making these technologies available at subsidized costs.

Technology has tremendous potential in truly bringing the clinical microbiology laboratory from the bench-side to the bedside. There is continous research and innovation in bringing newer technology and novel methods into routine practice. Integration of highly evolved software with technology has the potential to make the automated instruments more intuitive in terms of result reporting.

The future microbiology laboratory will see total laboratory automation, encompassing the entire spectrum of preanalytical, analytical, and post-analytical steps of testing. This will largely help the clinical microbiologist to focus on clinical reporting, moving away from the technical bench work. Automation thus can never replace the role of the clinical microbiologist but will continue to hugely complement their role in better patient diagnosis, care, and management.

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