Fever is one of the most common symptoms of illness in infants and represents a clinical challenge due to the potential for serious bacterial infection. As delayed treatment for these infections has been correlated with increased morbidity and mortality, broad-spectrum β-lactam antibiotics are often prescribed while waiting for microbiological lab results (1-3 days). However, the spread of antibiotic resistance via the β-lactamase enzyme, which can destroy β-lactam antibiotics, has confounded this paradigm; empiric antibiotic regimens are increasingly unable to cover all potential bacterial pathogens, leaving some infants effectively untreated until the pathogen is characterized. This can lead to lifelong sequela or death. Here, we introduce a fluorescent, microfluidic assay that can characterize β-lactamase derived antibiotic susceptibility in 20 min with a sensitivity suitable for direct human specimens. The protocol is extensible, and the antibiotic spectrum investigated can be feasibly adapted for the pathogens of regional relevance. This new assay fills an important need by providing the clinician with hitherto unavailable point of care information for treatment guidance in an inexpensive and simple diagnostic format.
Clinical Editor, Steven Schachter, MD
Point-of-care technologies are particularly valuable for clinical situations where rapid turn-around time for test results improves patient care by either guiding the selection of appropriate therapy that is urgently needed or by preventing the institution of unnecessary therapy. This is especially relevant to acute infections, where early institution of antibiotics that are appropriate for a given bacterial infection may prevent significant morbidity or mortality while inappropriate use for viral syndromes or the selection of the wrong antibiotic for a given bacterial infection may cause unnecessary complications.
Palanisami et al. describe a point-of-care, fluorescent, microfluidic assay designed to rapidly determine antibiotic susceptibility for a range of bacterial pathogens that commonly occur in patients seen in clinical practice. If validated in the clinic, this assay will help doctors select the appropriate antibiotic at the right time to the right patient, thereby speeding recovery from illness and reducing the societal threat of antibiotic resistance.
Note: Dr. Schachter is co-principal investigator for the National Institute of Biomedical Imaging and Bioengineering-funded Point of Care Technology in Primary Care center, which supported this work (Grant No. U54 EB015408).