Molecular Testing for Infectious Diseases Should Be Done in the Clinical Microbiology Laboratory
Molecular Testing for Infectious Diseases Should Be Done in the Clinical Microbiology Laboratory
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DOI：
10.1128/jcm.00488-12
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发表时间：
2012-06-01
影响因子：
9.4
通讯作者：
McAdam, Alexander J.
中科院分区：
文献类型：
--
作者：
Nolte, Frederick S.;McAdam, Alexander J.
在过去的十年中，在使用分子测试来诊断和管理传染病方面出现了爆炸式增长。HIV是一个典型的传染性病原体，其诊断至少在急性期，敏感性测试和管理都依赖于分子诊断。与传统方法相比，快速、简单、相对便宜地准确诊断大量呼吸道病原体的能力正在成为现实。直接测序和微阵列分析对从临床标本中直接检测各种生物体具有很大的希望。问题是这种检测应该在临床实验室的什么地方进行。至少出现了四种模式：分子传染病检测作为临床微生物实验室的一个分支；分子传染病检测在中心分子病理学实验室进行，由临床微生物学家领导；分子传染病检测在中心分子病理学实验室进行，由主要兴趣在分子病理学另一个领域的个人领导到参考实验室，而不是在现场或在机构的卫生保健系统内进行。我们已经询问了三位思考过这个非常复杂问题的人，请他们分享他们支持这些模型之一的基本原理。Frederick Nolte是南卡罗来纳医科大学临床实验室主任和分子病理学主任，活跃于AMP（分子病理学协会）并担任多个职位，是CLSI分子方法领域委员会主席，Alex McAdam是波士顿儿童医院传染病诊断部门主任，也是本杂志的编辑，他的同事Nima Mosammaparast，是波士顿儿童医院传染病诊断实验室助理主任。
Over the past decade, there has been an explosion in the use of molecular tests to diagnose and manage infectious diseases. HIV is a prime example of an infectious agent whose diagnosis at least in the acute stage, susceptibility testing, and management are all dependent on molecular diagnostics. The ability to accurately diagnose a plethora of respiratory pathogens quickly, simply, and relatively inexpensively compared to traditional methods is becoming a reality. Direct sequencing and microarray analysis holds great promise for directly detecting a wide variety of organisms from clinical specimens. The question is where this testing should be done in the clinical laboratory. There are at least four models that have emerged:Molecular infectious disease testing as an arm of the clinical microbiology laboratoryMolecular infectious disease testing done in a central molecular pathology laboratory under the leadership of a clinical microbiologistMolecular infectious disease testing done in a central molecular pathology laboratory under the leadership of an individual whose primary interest is in another area of molecular pathologyMolecular infectious disease testing sent to a reference laboratory and not done on site or within the institution's health care system.We have asked three individuals who have thought about this very complex issue to share their rationale for supporting one of these models. Frederick Nolte is the Director of Clinical Laboratories and Director of Molecular Pathology at the Medical University of South Carolina, is active in and held several positions of responsibility in AMP (Association of Molecular Pathology) and is Chair of the CLSI's Area Committee for Molecular Methods, Alex McAdam is the Director of the Infectious Diseases Diagnostic Division at Children's Hospital Boston and an editor of this journal, and his colleague, Nima Mosammaparast, is the Assistant Director of the Infectious Diseases Diagnostic Laboratory at Children's Hospital Boston.