Search

Introduction Bone and Joint Infections (BJI) are medically important, costly and occur in both native and prosthetic joints. Arthroplasties are expected to increase significantly in absolute numbers over time as well as the incidence of Prosthetic Joint Infections (PJI). Diagnosis of BJI and PJI is generally sub-optimal. The available diagnostic tests have variable effectiveness, are often below standard in sensitivity and/or specificity and carry a significant contamination risk during the collection of clinical samples. Improvement of diagnostics is urgently needed. Areas covered : We here provide a narrative review on current and future diagnostic microbiology technologies. Pathogen identification, antibiotic resistance detection and assessment of the epidemiology of infections via bacterial typing is considered useful for improved patient management. We here confirm the continuing importance of culture methods and the successful introduction of molecular, mass spectrometry-mediated and next generation genome sequencing technologies. The diagnostic algorithms for BJI must be better defined, especially in the context of the diversity of both disease phenotypes and clinical specimens rendered available. Expert opinion : Whether interventions in BJI or PJI are surgical or chemo-therapeutic (antibiotics and bacteriophages included), prior sensitive and specific pathogen detection remains a therapy-designing necessity. Innovative tests for earlier and more sensitive and specific detection of bacterial pathogens in BJI are urgently needed.

Therapeutic drug monitoring (TDM) of antibiotics has been practiced for more than half a century, but it is still not widely applied for infected patients. It has a traditional focus on limiting toxicity of specific classes of antibiotics such as aminoglycosides and vancomycin. With more patients in critical care with higher levels of sickness severity and immunosuppression as well as an increasingly obese and ageing population, an increasing risk of suboptimal antibiotic exposure continues to escalate. As such, the value of TDM continues to expand, especially for beta-lactams which constitute the most frequently used antibiotic class. To date, the minimum inhibitory concentration (MIC) of infectious microbes rather than classification in terms of susceptible and resistant can be reported. In parallel, increasingly sophisticated TDM technology is becoming available ensuring that TDM is feasible and can deliver personalized antibiotic dosing schemes. There is an obvious need for extensive studies that will quantify the improvements in clinical outcome of individual TDM-guided dosing. We suggest that a broad diagnostic and medical investigation of the TDM arena, including market analyses and analytical technology assessment, is a current priority.

Recently, plasmid-mediated and, therefore, transferable bacterial polymyxin resistance was discovered in strains from both humans and animals. Such a trait may widely spread geographically, while simultaneously crossing microbial species barriers. This may ultimately render the “last resort” polymyxin antibiotics therapeutically useless. Colistin is currently used to treat infections caused by Gram-negative carbapenemase producers and colistin resistance may lead to practical pan-antibiotic resistance. We here analyzed the medical and diagnostic consequences of (emerging) colistin resistance and propose pathways toward adequate diagnostics for timely detection of both asymptomatic carriage and infection. Culture-based testing using chromogenic and selective media for screening clinical (and veterinary) specimens may constitute key tools for that purpose. Relevant molecular tests are also discussed.

(Global-PPS): a Worldwide Antimicrobial Web-based Point Prevalence Survey Ann Versporten1; Nico Drapier1;, Peter Zarb2; Isabelle Caniaux3; Marie Francoise Gros3; Mark Miller3; Vincent Jarlier4; Dilip Nathwani5 and Herman Goossens1 1Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute (VAXINFECTIO), Faculty of Medicine and Health Science, University of Antwerp, Antwerp, Belgium; 2Mater Dei Hospital, Msida, Malta; 3 bioMerieux, Marcy l’Etoile, France; 4 Laboratoire De Bacteriologie-Hygiene, Faculte de Medicine Pitie-Salpetriere, Paris, France; 5 Ninewells Hospital and Medical Scholl Dundee, Dundee, Scotland. IDWeek, San Diego, CA – 7-11 October 2015 (poster N° 147)