Clinical Review Science, medicine, and the future

Near patient microbiological tests

BMJ 1999; 319 doi: https://doi.org/10.1136/bmj.319.7205.298 (Published 31 July 1999) Cite this as: BMJ 1999;319:298
  1. S P Borriello, director (PBorriello@phls.nhs.uk)
  1. PHLS Central Public Health Laboratory, London NW9 5HT

    A revolution is occurring in the detection, identification, and characterisation of pathogens by the combining of the seemingly disparate fields of nucleic acid analysis, bioinformatics, data storage and retrieval, nanotechnology, physics, microelectronics, and polymer, solid state, and combinatorial chemistry. The scenario of taking a drop of blood, urine, or saliva and within an hour knowing whether a pathogen is present and its antimicrobial resistance potential is no longer science fiction but will soon be reality. These developments, particularly with regard to near patient testing, have important implications for the delivery of health care They will affect primary care, prescribing practice, organisation of pathology laboratories, counselling services, surveillance and epidemiology, and medicolegal practice.

    Near patient testing could be implemented in various settings—at hospital bedside, in an outpatient clinic, in a dental or general practice surgery, or in a patient's home. Testing kits might be complete diagnostic units, needing no processing other than application of test material and yielding instant results, or they may need manipulation of test material or use of other equipment for the test to be read and interpreted.

    Developments enabling near patient testing

    The main driving forces behind the development of such testing kits have been the search for life in space exploration and the military's need to detect agents of biological warfare. In both cases miniaturisation and robustness of detection systems have been necessary. Systems for detecting biological weapons must be able to rapidly detect and identify a variety of pathogens or their virulence factors, particularly toxins.

    Antibody based systems

    Many new test kit technologies coming on to the market for patient diagnosis are still based on antigen-antibody interactions, an old diagnostic technology. The developments that have permitted near patient testing are in new detection systems for antigen-antibody complexes, allowing results to be read by eye, use of a control that is built into the …

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