Emerging microbiology diagnostics for transplant infections: On the cusp of a paradigm shift.

Azar, Marwan M; Gaston, David C; Kotton, Camille N; Malinis, Maricar F

In light of the heightened risk for infection associated with solid organ and hematopoietic stem cell transplantation, rapid and accurate microbiology diagnostics are essential to the practice of transplant clinicians, including infectious diseases specialists. In the last decade, diagnostic microbiology has seen a shift towards culture-independent techniques including single-target and multiplexed molecular testing, mass-spectrometry, and magnetic resonance-based methods which have together greatly expanded the array of pathogens identified, increased processing speed and throughput, allowed for detection of resistance determinants, and ultimately improved the outcomes of infected transplant recipients. More recently, a newer generation of diagnostics with immense potential has emerged, including multiplexed molecular panels directly applicable to blood and blood culture specimens, next-generation metagenomics and gas chromatography mass spectrometry. Though these methods have some recognized drawbacks, many have already demonstrated improved diagnostic sensitivity and a positive impact on clinical outcomes in transplant and immunocompromised patients.