New and developing diagnostic technologies for urinary tract infections.
New and developing diagnostic technologies for urinary tract infections.
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DOI：
10.1038/nrurol.2017.20
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发表时间：
2017-05
期刊：
影响因子：
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通讯作者：
Liao JC
中科院分区：
文献类型：
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作者：
Davenport M;Mach KE;Shortliffe LMD;Banaei N;Wang TH;Liao JC
及时准确地鉴定和确定尿路病原体的抗菌药物敏感性是管理尿路感染的核心。尿液试纸快速且易于进行即时检测，但不具有足够的诊断准确性或提供微生物诊断。尿培养与抗菌药物敏感性测试需要2 - 3天，需要一个临床实验室。经验性抗生素的普遍使用导致了耐多药微生物的增加，减少了治疗选择并增加了成本。除了改进抗菌剂管理和开发新的抗菌剂外，还需要新的诊断方法来及时鉴定微生物和确定抗菌剂的敏感性。新的诊断平台，包括核酸检测和质谱分析，已被批准用于临床，并提高了从原代培养物中鉴定病原体的速度和准确性。优化直接尿液检测将缩短诊断时间，但这些技术不能提供有关抗菌药物敏感性的全面信息。包括生物传感器，微流体和其他集成平台在内的新兴技术可以通过尿液样本中的直接病原体检测，快速抗菌药物敏感性测试和即时检测来改善UTI诊断。这些技术的成功开发和实施有可能迎来一个精准医疗时代，以改善患者护理和公共卫生。
Timely and accurate identification and determination of the antimicrobial susceptibility of uropathogens is central to the management of UTIs. Urine dipsticks are fast and amenable to point-of-care testing, but do not have adequate diagnostic accuracy or provide microbiological diagnosis. Urine culture with antimicrobial susceptibility testing takes 2 3 days and requires a clinical laboratory. The common use of empirical antibiotics has contributed to the rise of multidrug-resistant organisms, reducing treatment options and increasing costs. In addition to improved antimicrobial stewardship and the development of new antimicrobials, novel diagnostics are needed for timely microbial identification and determination of antimicrobial susceptibilities. New diagnostic platforms, including nucleic acid tests and mass spectrometry, have been approved for clinical use and have improved the speed and accuracy of pathogen identification from primary cultures. Optimization for direct urine testing would reduce the time to diagnosis, yet these technologies do not provide comprehensive information on antimicrobial susceptibility. Emerging technologies including biosensors, microfluidics, and other integrated platforms could improve UTI diagnosis via direct pathogen detection from urine samples, rapid antimicrobial susceptibility testing, and point-of-care testing. Successful development and implementation of these technologies has the potential to usher in an era of precision medicine to improve patient care and public health.