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Practical Guidance for Clinical Microbiology Laboratories: Microbiologic diagnosis of implant-associated infections
Marisa Ann Azad1,2, Robin Patel3,4
1Division of Infectious Diseases, Department of Medicine, The Ottawa Hospital, Ottawa, Canada.
Abstract:
SUMMARYImplant-associated infections (IAIs) pose serious threats to patients and can be associated with significant morbidity and mortality. These infections may be difficult to diagnose due, in part, to biofilm formation on device surfaces, and because even when microbes are found, their clinical significance may be unclear. Despite recent advances in laboratory testing, IAIs remain a diagnostic challenge. From a therapeutic standpoint, many IAIs currently require device removal and prolonged courses of antimicrobial therapy to effect a cure. Therefore, making an accurate diagnosis, defining both the presence of infection and the involved microorganisms, is paramount. The sensitivity of standard microbial culture for IAI diagnosis varies depending on the type of IAI, the specimen analyzed, and the culture technique(s) used. Although IAI-specific culture-based diagnostics have been described, the challenge of culture-negative IAIs remains. Given this, molecular assays, including both nucleic acid amplification tests and next-generation sequencing-based assays, have been used. In this review, an overview of these challenging infections is presented, as well as an approach to their diagnosis from a microbiologic perspective.
Insights
Diagnosing implant-associated infections (IAIs) is challenging due to biofilms and unclear microbial significance. This review explores microbiologic diagnostic approaches for IAIs, including molecular assays.
Area of Science:
- Microbiology
- Infectious Diseases
- Biomedical Engineering
Background:
- Implant-associated infections (IAIs) present significant patient morbidity and mortality risks.
- Biofilm formation on devices complicates IAI diagnosis and treatment.
- Accurate microbial identification is crucial for effective IAI management.
Purpose of the Study:
- To review the challenges in diagnosing implant-associated infections (IAIs).
- To present microbiologic diagnostic strategies for IAIs.
- To highlight the role of molecular assays in IAI diagnosis.
Main Methods:
- Review of current literature on IAI diagnostics.
- Analysis of traditional culture-based methods and their limitations.
- Evaluation of molecular diagnostic techniques, including nucleic acid amplification tests and next-generation sequencing.
Main Results:
- Standard microbial cultures show variable sensitivity for IAI diagnosis.
- Culture-negative IAIs remain a significant diagnostic hurdle.
- Molecular assays offer promising alternatives for detecting microorganisms in IAIs.
Conclusions:
- Accurate diagnosis of IAIs is paramount for successful patient outcomes.
- Molecular diagnostics are increasingly important for overcoming challenges in IAI detection.
- Further research into optimized diagnostic approaches for IAIs is warranted.
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