Clinical Review Recent advances

Medical microbiology

BMJ 1998; 317 doi: https://doi.org/10.1136/bmj.317.7165.1060 (Published 17 October 1998) Cite this as: BMJ 1998;317:1060
  1. Harold Richardson, professor emeritus (richardson@lptp.on.ca),
  2. Fiona Smaill, associate professor
  1. Divisions of Medical Microbiology and Infectious Diseases, Departments of Pathology and Medicine, Faculty of Health Science, McMaster University, Hamilton, Ontario, Canada L8N 3Z5
  1. Correspondence to: Professor H Richardson, Room 2N30, McMaster University Medical Centre, Hamilton, Ontario, Canada L8N 3Z5

    Adequate clinical management of infectious diseases relies primarily on the accurate identification of the causal micro-organism and the production of reliable information on its antimicrobial susceptibility.1Traditional diagnostic methods in microbiology have limited the ability of laboratories to provide doctors with timely and clinically relevant information, but recent technology provides results in minutes or hours rather than days or weeks. In particular, molecular biological techniques have increased the speed and sensitivity of detection methods, as well as allowing laboratories to identify organisms that do not grow or grow slowly in culture. These techniques also allow microbiologists to identify genes that result in resistance to antibiotics and to “fingerprint” individual isolates for epidemiological tracking.2Recognition of newly emerging infectious diseases and control of antibiotic resistance in Streptococcus pneumoniae,Haemophilus influenzae,Moraxella catarrhalis,Staphylococcus aureus, and common Gram negative bacilli will rely heavily on these new technologies.

    Method

    We have included references that provide critical information on new approaches to the laboratory diagnosis of infectious diseases. Most were identified by us during our review of the literature, with additional references being found with a Medline search using Grateful Med as the search engine. We searched under the terms infectious diseases, diagnosis, and laboratory.

    We have included citations to reviews and to studies that critically compared a new method with an established standard method. Trials in diagnostic microbiology often do not comply with a randomised, double blind design, and we have included only those that meet currently acceptable study design.

    New diagnostic methods

    Immunoassays

    Detection of microbial antigens in clinical samples has great potential for rapid diagnosis. Latex particle agglutination and coagglutination tests, enzyme linked immunoassays, and direct immunofluorescence antibody assays have been available for some years. Although medical microbiology laboratories have recognised the benefits of using these tests (technical simplicity, rapidity, …

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